Kau Hospital

All Charges

Charge

Type

Setting

Price

MITOMYCIN 5 MG/10ML IV (WET SOLR VIAL) [43010632]

Facility

$409.00

Service Code	HCPCS J9280
Hospital Revenue Code	636
Min. Negotiated Rate	$28.27
Max. Negotiated Rate	$396.73
Rate for Payer: AlohaCare Medicaid	$204.50
Rate for Payer: AlohaCare Medicare	$126.79
Rate for Payer: Cash Price	$245.40
Rate for Payer: Cash Price	$245.40
Rate for Payer: Devoted Health Medicare	$139.06
Rate for Payer: Hawaii Medical Service Association ABD	$28.27
Rate for Payer: Hawaii Medical Service Association Commercial	$35.58
Rate for Payer: Hawaii Medical Service Association Medicare	$126.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.27
Rate for Payer: Hawaii Western Management Group Commercial	$388.55
Rate for Payer: Health Management Network Commercial	$347.65
Rate for Payer: Humana Medicare	$126.79
Rate for Payer: Kaiser Permanente Commercial	$368.10
Rate for Payer: Kaiser Permanente Medicaid	$208.59
Rate for Payer: Kaiser Permanente Medicare	$126.79
Rate for Payer: MDX Hawaii PPO	$396.73
Rate for Payer: Ohana Health Plan Medicaid	$126.79
Rate for Payer: Ohana Health Plan Medicare	$126.79
Rate for Payer: UnitedHealthcare Medicaid	$245.40
Rate for Payer: UnitedHealthcare Medicare	$126.79
Rate for Payer: University Health Alliance Commercial	$298.12

MITOMYCIN 5 MG/10ML IV (WET SOLR VIAL) [43010632]

Facility

$409.00

Service Code	HCPCS J9280
Hospital Revenue Code	250
Min. Negotiated Rate	$347.65
Max. Negotiated Rate	$396.73
Rate for Payer: Cash Price	$245.40
Rate for Payer: Health Management Network Commercial	$347.65
Rate for Payer: Kaiser Permanente Commercial	$368.10
Rate for Payer: MDX Hawaii PPO	$396.73

MITOMYCIN 5 MG INTRAVENOUS SOLUTION [10632]

Facility

$1,210.00

Service Code	HCPCS J9280
Hospital Revenue Code	250
Min. Negotiated Rate	$1,028.50
Max. Negotiated Rate	$1,173.70
Rate for Payer: Cash Price	$726.00
Rate for Payer: Cash Price	$245.40
Rate for Payer: Health Management Network Commercial	$347.65
Rate for Payer: Health Management Network Commercial	$1,028.50
Rate for Payer: Kaiser Permanente Commercial	$1,089.00
Rate for Payer: Kaiser Permanente Commercial	$368.10
Rate for Payer: MDX Hawaii PPO	$1,173.70
Rate for Payer: MDX Hawaii PPO	$396.73

MITOMYCIN 5 MG INTRAVENOUS SOLUTION [10632]

Facility

$1,210.00

Service Code	HCPCS J9280
Hospital Revenue Code	636
Min. Negotiated Rate	$28.27
Max. Negotiated Rate	$1,173.70
Rate for Payer: AlohaCare Medicaid	$605.00
Rate for Payer: AlohaCare Medicaid	$204.50
Rate for Payer: AlohaCare Medicare	$126.79
Rate for Payer: AlohaCare Medicare	$375.10
Rate for Payer: Cash Price	$726.00
Rate for Payer: Cash Price	$726.00
Rate for Payer: Cash Price	$245.40
Rate for Payer: Cash Price	$245.40
Rate for Payer: Devoted Health Medicare	$411.40
Rate for Payer: Devoted Health Medicare	$139.06
Rate for Payer: Hawaii Medical Service Association ABD	$28.27
Rate for Payer: Hawaii Medical Service Association ABD	$28.27
Rate for Payer: Hawaii Medical Service Association Commercial	$35.58
Rate for Payer: Hawaii Medical Service Association Commercial	$35.58
Rate for Payer: Hawaii Medical Service Association Medicare	$375.10
Rate for Payer: Hawaii Medical Service Association Medicare	$126.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.27
Rate for Payer: Hawaii Western Management Group Commercial	$1,149.50
Rate for Payer: Hawaii Western Management Group Commercial	$388.55
Rate for Payer: Health Management Network Commercial	$1,028.50
Rate for Payer: Health Management Network Commercial	$347.65
Rate for Payer: Humana Medicare	$375.10
Rate for Payer: Humana Medicare	$126.79
Rate for Payer: Kaiser Permanente Commercial	$1,089.00
Rate for Payer: Kaiser Permanente Commercial	$368.10
Rate for Payer: Kaiser Permanente Medicaid	$617.10
Rate for Payer: Kaiser Permanente Medicaid	$208.59
Rate for Payer: Kaiser Permanente Medicare	$375.10
Rate for Payer: Kaiser Permanente Medicare	$126.79
Rate for Payer: MDX Hawaii PPO	$1,173.70
Rate for Payer: MDX Hawaii PPO	$396.73
Rate for Payer: Ohana Health Plan Medicaid	$126.79
Rate for Payer: Ohana Health Plan Medicaid	$375.10
Rate for Payer: Ohana Health Plan Medicare	$375.10
Rate for Payer: Ohana Health Plan Medicare	$126.79
Rate for Payer: UnitedHealthcare Medicaid	$726.00
Rate for Payer: UnitedHealthcare Medicaid	$245.40
Rate for Payer: UnitedHealthcare Medicare	$126.79
Rate for Payer: UnitedHealthcare Medicare	$375.10
Rate for Payer: University Health Alliance Commercial	$881.97
Rate for Payer: University Health Alliance Commercial	$298.12

M/L TAPER 9 STD 00-7711-009-00

Facility

$5,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,912.00
Max. Negotiated Rate	$5,044.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,640.00
Rate for Payer: Health Management Network Commercial	$4,420.00
Rate for Payer: Kaiser Permanente Commercial	$4,680.00
Rate for Payer: MDX Hawaii PPO	$5,044.00
Rate for Payer: University Health Alliance Commercial	$2,912.00

M/L TAPER 9 STD 00-7711-009-00

Facility

$5,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.00
Max. Negotiated Rate	$5,044.00
Rate for Payer: AlohaCare Medicaid	$2,600.00
Rate for Payer: AlohaCare Medicare	$1,612.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Devoted Health Medicare	$1,768.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,612.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,640.00
Rate for Payer: Health Management Network Commercial	$4,420.00
Rate for Payer: Humana Medicare	$1,612.00
Rate for Payer: Kaiser Permanente Commercial	$4,680.00
Rate for Payer: Kaiser Permanente Medicaid	$2,652.00
Rate for Payer: Kaiser Permanente Medicare	$1,612.00
Rate for Payer: MDX Hawaii PPO	$5,044.00
Rate for Payer: Ohana Health Plan Medicaid	$1,612.00
Rate for Payer: Ohana Health Plan Medicare	$1,612.00
Rate for Payer: UnitedHealthcare Medicare	$1,612.00
Rate for Payer: University Health Alliance Commercial	$2,912.00

MODAFINIL 100 MG TABLET [24702]

Facility

$66.00

Service Code	NDC 68084062121
Hospital Revenue Code	637
Min. Negotiated Rate	$20.46
Max. Negotiated Rate	$64.02
Rate for Payer: AlohaCare Medicaid	$33.00
Rate for Payer: AlohaCare Medicare	$20.46
Rate for Payer: Cash Price	$39.60
Rate for Payer: Devoted Health Medicare	$22.44
Rate for Payer: Hawaii Medical Service Association Medicare	$20.46
Rate for Payer: Hawaii Western Management Group Commercial	$62.70
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Humana Medicare	$20.46
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: Kaiser Permanente Medicare	$20.46
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: Ohana Health Plan Medicaid	$20.46
Rate for Payer: Ohana Health Plan Medicare	$20.46
Rate for Payer: UnitedHealthcare Medicare	$20.46
Rate for Payer: University Health Alliance Commercial	$48.11

MODAFINIL 100 MG TABLET [24702]

Facility

$28.00

Service Code	NDC 00904679104
Hospital Revenue Code	637
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$27.16
Rate for Payer: AlohaCare Medicaid	$14.00
Rate for Payer: AlohaCare Medicare	$8.68
Rate for Payer: Cash Price	$16.80
Rate for Payer: Devoted Health Medicare	$9.52
Rate for Payer: Hawaii Medical Service Association Medicare	$8.68
Rate for Payer: Hawaii Western Management Group Commercial	$26.60
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Humana Medicare	$8.68
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$14.28
Rate for Payer: Kaiser Permanente Medicare	$8.68
Rate for Payer: MDX Hawaii PPO	$27.16
Rate for Payer: Ohana Health Plan Medicaid	$8.68
Rate for Payer: Ohana Health Plan Medicare	$8.68
Rate for Payer: UnitedHealthcare Medicare	$8.68
Rate for Payer: University Health Alliance Commercial	$20.41

MODAFINIL 100 MG TABLET [24702]

Facility

$66.00

Service Code	NDC 68084062121
Hospital Revenue Code	250
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$39.60
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: MDX Hawaii PPO	$64.02

MODAFINIL 100 MG TABLET [24702]

Facility

$28.00

Service Code	NDC 00904679104
Hospital Revenue Code	250
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$16.80
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: MDX Hawaii PPO	$27.16

MODIFIED LANOLIN 100 % TOPICAL CREAM [170446]

Facility

$10.00

Service Code	NDC 10202000000
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: MDX Hawaii PPO	$9.70

MODIFIED LANOLIN 100 % TOPICAL CREAM [170446]

Facility

$10.00

Service Code	NDC 10202000000
Hospital Revenue Code	637
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$9.70
Rate for Payer: AlohaCare Medicaid	$5.00
Rate for Payer: AlohaCare Medicare	$3.10
Rate for Payer: Cash Price	$6.00
Rate for Payer: Devoted Health Medicare	$3.40
Rate for Payer: Hawaii Medical Service Association Medicare	$3.10
Rate for Payer: Hawaii Western Management Group Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Humana Medicare	$3.10
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: Kaiser Permanente Medicaid	$5.10
Rate for Payer: Kaiser Permanente Medicare	$3.10
Rate for Payer: MDX Hawaii PPO	$9.70
Rate for Payer: Ohana Health Plan Medicaid	$3.10
Rate for Payer: Ohana Health Plan Medicare	$3.10
Rate for Payer: UnitedHealthcare Medicare	$3.10
Rate for Payer: University Health Alliance Commercial	$7.29

MODULAR FLEX DRILL BIT 30MM

Facility

$818.00

Hospital Revenue Code	272
Min. Negotiated Rate	$253.58
Max. Negotiated Rate	$793.46
Rate for Payer: AlohaCare Medicaid	$409.00
Rate for Payer: AlohaCare Medicare	$253.58
Rate for Payer: Cash Price	$490.80
Rate for Payer: Devoted Health Medicare	$278.12
Rate for Payer: Hawaii Medical Service Association Medicare	$253.58
Rate for Payer: Hawaii Western Management Group Commercial	$777.10
Rate for Payer: Health Management Network Commercial	$695.30
Rate for Payer: Humana Medicare	$253.58
Rate for Payer: Kaiser Permanente Commercial	$736.20
Rate for Payer: Kaiser Permanente Medicaid	$417.18
Rate for Payer: Kaiser Permanente Medicare	$253.58
Rate for Payer: MDX Hawaii PPO	$793.46
Rate for Payer: Ohana Health Plan Medicaid	$253.58
Rate for Payer: Ohana Health Plan Medicare	$253.58
Rate for Payer: UnitedHealthcare Medicare	$253.58
Rate for Payer: University Health Alliance Commercial	$596.24

MODULAR FLEX DRILL BIT 30MM

Facility

$818.00

Hospital Revenue Code	272
Min. Negotiated Rate	$695.30
Max. Negotiated Rate	$793.46
Rate for Payer: Cash Price	$490.80
Rate for Payer: Health Management Network Commercial	$695.30
Rate for Payer: Kaiser Permanente Commercial	$736.20
Rate for Payer: MDX Hawaii PPO	$793.46

MODULAR HIIP SYS 6276-1-025

Facility

$8,969.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,780.39
Max. Negotiated Rate	$8,699.93
Rate for Payer: AlohaCare Medicaid	$4,484.50
Rate for Payer: AlohaCare Medicare	$2,780.39
Rate for Payer: Cash Price	$5,381.40
Rate for Payer: Devoted Health Medicare	$3,049.46
Rate for Payer: Hawaii Medical Service Association Medicare	$2,780.39
Rate for Payer: Hawaii Western Management Group Commercial	$6,278.30
Rate for Payer: Health Management Network Commercial	$7,623.65
Rate for Payer: Humana Medicare	$2,780.39
Rate for Payer: Kaiser Permanente Commercial	$8,072.10
Rate for Payer: Kaiser Permanente Medicaid	$4,574.19
Rate for Payer: Kaiser Permanente Medicare	$2,780.39
Rate for Payer: MDX Hawaii PPO	$8,699.93
Rate for Payer: Ohana Health Plan Medicaid	$2,780.39
Rate for Payer: Ohana Health Plan Medicare	$2,780.39
Rate for Payer: UnitedHealthcare Medicare	$2,780.39
Rate for Payer: University Health Alliance Commercial	$5,022.64

MODULAR HIIP SYS 6276-1-025

Facility

$8,969.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,022.64
Max. Negotiated Rate	$8,699.93
Rate for Payer: Cash Price	$5,381.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,278.30
Rate for Payer: Health Management Network Commercial	$7,623.65
Rate for Payer: Kaiser Permanente Commercial	$8,072.10
Rate for Payer: MDX Hawaii PPO	$8,699.93
Rate for Payer: University Health Alliance Commercial	$5,022.64

MODULAR HIP STEM 6276-1-023

Facility

$8,879.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,752.49
Max. Negotiated Rate	$8,612.63
Rate for Payer: AlohaCare Medicaid	$4,439.50
Rate for Payer: AlohaCare Medicare	$2,752.49
Rate for Payer: Cash Price	$5,327.40
Rate for Payer: Devoted Health Medicare	$3,018.86
Rate for Payer: Hawaii Medical Service Association Medicare	$2,752.49
Rate for Payer: Hawaii Western Management Group Commercial	$6,215.30
Rate for Payer: Health Management Network Commercial	$7,547.15
Rate for Payer: Humana Medicare	$2,752.49
Rate for Payer: Kaiser Permanente Commercial	$7,991.10
Rate for Payer: Kaiser Permanente Medicaid	$4,528.29
Rate for Payer: Kaiser Permanente Medicare	$2,752.49
Rate for Payer: MDX Hawaii PPO	$8,612.63
Rate for Payer: Ohana Health Plan Medicaid	$2,752.49
Rate for Payer: Ohana Health Plan Medicare	$2,752.49
Rate for Payer: UnitedHealthcare Medicare	$2,752.49
Rate for Payer: University Health Alliance Commercial	$4,972.24

MODULAR HIP STEM 6276-1-023

Facility

$8,879.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,972.24
Max. Negotiated Rate	$8,612.63
Rate for Payer: Cash Price	$5,327.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,215.30
Rate for Payer: Health Management Network Commercial	$7,547.15
Rate for Payer: Kaiser Permanente Commercial	$7,991.10
Rate for Payer: MDX Hawaii PPO	$8,612.63
Rate for Payer: University Health Alliance Commercial	$4,972.24

MODULAR RADIAL HEAD 11-210044

Facility

$4,280.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,326.80
Max. Negotiated Rate	$4,151.60
Rate for Payer: AlohaCare Medicaid	$2,140.00
Rate for Payer: AlohaCare Medicare	$1,326.80
Rate for Payer: Cash Price	$2,568.00
Rate for Payer: Devoted Health Medicare	$1,455.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,326.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,996.00
Rate for Payer: Health Management Network Commercial	$3,638.00
Rate for Payer: Humana Medicare	$1,326.80
Rate for Payer: Kaiser Permanente Commercial	$3,852.00
Rate for Payer: Kaiser Permanente Medicaid	$2,182.80
Rate for Payer: Kaiser Permanente Medicare	$1,326.80
Rate for Payer: MDX Hawaii PPO	$4,151.60
Rate for Payer: Ohana Health Plan Medicaid	$1,326.80
Rate for Payer: Ohana Health Plan Medicare	$1,326.80
Rate for Payer: UnitedHealthcare Medicare	$1,326.80
Rate for Payer: University Health Alliance Commercial	$2,396.80

MODULAR RADIAL HEAD 11-210044

Facility

$4,280.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,396.80
Max. Negotiated Rate	$4,151.60
Rate for Payer: Cash Price	$2,568.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,996.00
Rate for Payer: Health Management Network Commercial	$3,638.00
Rate for Payer: Kaiser Permanente Commercial	$3,852.00
Rate for Payer: MDX Hawaii PPO	$4,151.60
Rate for Payer: University Health Alliance Commercial	$2,396.80

MODULAR RADIAL STEM 11-210063

Facility

$4,280.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,326.80
Max. Negotiated Rate	$4,151.60
Rate for Payer: AlohaCare Medicaid	$2,140.00
Rate for Payer: AlohaCare Medicare	$1,326.80
Rate for Payer: Cash Price	$2,568.00
Rate for Payer: Devoted Health Medicare	$1,455.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,326.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,996.00
Rate for Payer: Health Management Network Commercial	$3,638.00
Rate for Payer: Humana Medicare	$1,326.80
Rate for Payer: Kaiser Permanente Commercial	$3,852.00
Rate for Payer: Kaiser Permanente Medicaid	$2,182.80
Rate for Payer: Kaiser Permanente Medicare	$1,326.80
Rate for Payer: MDX Hawaii PPO	$4,151.60
Rate for Payer: Ohana Health Plan Medicaid	$1,326.80
Rate for Payer: Ohana Health Plan Medicare	$1,326.80
Rate for Payer: UnitedHealthcare Medicare	$1,326.80
Rate for Payer: University Health Alliance Commercial	$2,396.80

MODULAR RADIAL STEM 11-210063

Facility

$4,280.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,396.80
Max. Negotiated Rate	$4,151.60
Rate for Payer: Cash Price	$2,568.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,996.00
Rate for Payer: Health Management Network Commercial	$3,638.00
Rate for Payer: Kaiser Permanente Commercial	$3,852.00
Rate for Payer: MDX Hawaii PPO	$4,151.60
Rate for Payer: University Health Alliance Commercial	$2,396.80

MODULE TL DYNA 54-24100

Facility

$1,400.00

Hospital Revenue Code	272
Min. Negotiated Rate	$434.00
Max. Negotiated Rate	$1,358.00
Rate for Payer: AlohaCare Medicaid	$700.00
Rate for Payer: AlohaCare Medicare	$434.00
Rate for Payer: Cash Price	$840.00
Rate for Payer: Devoted Health Medicare	$476.00
Rate for Payer: Hawaii Medical Service Association Medicare	$434.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,330.00
Rate for Payer: Health Management Network Commercial	$1,190.00
Rate for Payer: Humana Medicare	$434.00
Rate for Payer: Kaiser Permanente Commercial	$1,260.00
Rate for Payer: Kaiser Permanente Medicaid	$714.00
Rate for Payer: Kaiser Permanente Medicare	$434.00
Rate for Payer: MDX Hawaii PPO	$1,358.00
Rate for Payer: Ohana Health Plan Medicaid	$434.00
Rate for Payer: Ohana Health Plan Medicare	$434.00
Rate for Payer: UnitedHealthcare Medicare	$434.00
Rate for Payer: University Health Alliance Commercial	$1,020.46

MODULE TL DYNA 54-24100

Facility

$1,400.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,190.00
Max. Negotiated Rate	$1,358.00
Rate for Payer: Cash Price	$840.00
Rate for Payer: Health Management Network Commercial	$1,190.00
Rate for Payer: Kaiser Permanente Commercial	$1,260.00
Rate for Payer: MDX Hawaii PPO	$1,358.00

MODULE TL STERILE 99-54-24100

Facility

$1,400.00

Hospital Revenue Code	272
Min. Negotiated Rate	$434.00
Max. Negotiated Rate	$1,358.00
Rate for Payer: AlohaCare Medicaid	$700.00
Rate for Payer: AlohaCare Medicare	$434.00
Rate for Payer: Cash Price	$840.00
Rate for Payer: Devoted Health Medicare	$476.00
Rate for Payer: Hawaii Medical Service Association Medicare	$434.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,330.00
Rate for Payer: Health Management Network Commercial	$1,190.00
Rate for Payer: Humana Medicare	$434.00
Rate for Payer: Kaiser Permanente Commercial	$1,260.00
Rate for Payer: Kaiser Permanente Medicaid	$714.00
Rate for Payer: Kaiser Permanente Medicare	$434.00
Rate for Payer: MDX Hawaii PPO	$1,358.00
Rate for Payer: Ohana Health Plan Medicaid	$434.00
Rate for Payer: Ohana Health Plan Medicare	$434.00
Rate for Payer: UnitedHealthcare Medicare	$434.00
Rate for Payer: University Health Alliance Commercial	$1,020.46

Know your out-of-pocket cost for care.

All Charges