Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Bill Only AP 88175 Thin Prep Pap

Facility

$316.00

Service Code	HCPCS 88175
Hospital Charge Code	8264980
Hospital Revenue Code	311
Min. Negotiated Rate	$268.60
Max. Negotiated Rate	$306.52
Rate for Payer: Cash Price	$205.40
Rate for Payer: Health Management Network Commercial	$268.60
Rate for Payer: Kaiser Permanente Commercial	$284.40
Rate for Payer: MDX Hawaii PPO	$306.52

Bill Only AP 88184 Flow Cytometry 1st Marker

Facility

$746.00

Service Code	HCPCS 88184
Hospital Charge Code	8102065
Hospital Revenue Code	311
Min. Negotiated Rate	$634.10
Max. Negotiated Rate	$723.62
Rate for Payer: Cash Price	$484.90
Rate for Payer: Health Management Network Commercial	$634.10
Rate for Payer: Kaiser Permanente Commercial	$671.40
Rate for Payer: MDX Hawaii PPO	$723.62

Bill Only AP 88184 Flow Cytometry 1st Marker

Facility

$746.00

Service Code	HCPCS 88184
Hospital Charge Code	8102065
Hospital Revenue Code	311
Min. Negotiated Rate	$40.71
Max. Negotiated Rate	$723.62
Rate for Payer: AlohaCare Medicaid	$373.00
Rate for Payer: AlohaCare Medicare	$373.00
Rate for Payer: Cash Price	$484.90
Rate for Payer: Cash Price	$484.90
Rate for Payer: Devoted Health Medicare	$410.30
Rate for Payer: Hawaii Medical Service Association ABD	$40.71
Rate for Payer: Hawaii Medical Service Association Commercial	$457.76
Rate for Payer: Hawaii Medical Service Association Medicare	$373.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$44.43
Rate for Payer: Hawaii Western Management Group Commercial	$366.21
Rate for Payer: Health Management Network Commercial	$634.10
Rate for Payer: Humana Medicare	$373.00
Rate for Payer: Kaiser Permanente Commercial	$671.40
Rate for Payer: Kaiser Permanente Medicaid	$380.46
Rate for Payer: Kaiser Permanente Medicare	$373.00
Rate for Payer: MDX Hawaii PPO	$723.62
Rate for Payer: Ohana Health Plan Medicaid	$373.00
Rate for Payer: Ohana Health Plan Medicare	$373.00
Rate for Payer: UnitedHealthcare Medicaid	$40.71
Rate for Payer: UnitedHealthcare Medicare	$373.00
Rate for Payer: University Health Alliance Commercial	$152.44

Bill Only AP 88185 Flow Cytometry Ea Addl Marker

Facility

$230.00

Service Code	HCPCS 88185
Hospital Charge Code	8102066
Hospital Revenue Code	311
Min. Negotiated Rate	$195.50
Max. Negotiated Rate	$223.10
Rate for Payer: Cash Price	$149.50
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: MDX Hawaii PPO	$223.10

Bill Only AP 88185 Flow Cytometry Ea Addl Marker

Facility

$230.00

Service Code	HCPCS 88185
Hospital Charge Code	8102066
Hospital Revenue Code	311
Min. Negotiated Rate	$19.96
Max. Negotiated Rate	$223.10
Rate for Payer: AlohaCare Medicaid	$115.00
Rate for Payer: AlohaCare Medicare	$115.00
Rate for Payer: Cash Price	$149.50
Rate for Payer: Cash Price	$149.50
Rate for Payer: Devoted Health Medicare	$126.50
Rate for Payer: Hawaii Medical Service Association ABD	$19.96
Rate for Payer: Hawaii Medical Service Association Medicare	$115.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.79
Rate for Payer: Hawaii Western Management Group Commercial	$218.50
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Humana Medicare	$115.00
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: Kaiser Permanente Medicaid	$117.30
Rate for Payer: Kaiser Permanente Medicare	$115.00
Rate for Payer: MDX Hawaii PPO	$223.10
Rate for Payer: Ohana Health Plan Medicaid	$115.00
Rate for Payer: Ohana Health Plan Medicare	$115.00
Rate for Payer: UnitedHealthcare Medicaid	$19.96
Rate for Payer: UnitedHealthcare Medicare	$115.00
Rate for Payer: University Health Alliance Commercial	$86.75

Bill Only AP 88300 Surg Level I

Facility

$201.00

Service Code	HCPCS 88300 TC
Hospital Charge Code	8196778
Hospital Revenue Code	310
Min. Negotiated Rate	$170.85
Max. Negotiated Rate	$194.97
Rate for Payer: Cash Price	$130.65
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: MDX Hawaii PPO	$194.97

Bill Only AP 88300 Surg Level I

Facility

$201.00

Service Code	HCPCS 88300 TC
Hospital Charge Code	8196778
Hospital Revenue Code	310
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$194.97
Rate for Payer: AlohaCare Medicaid	$100.50
Rate for Payer: AlohaCare Medicare	$100.50
Rate for Payer: Cash Price	$130.65
Rate for Payer: Cash Price	$130.65
Rate for Payer: Devoted Health Medicare	$110.55
Rate for Payer: Hawaii Medical Service Association ABD	$13.56
Rate for Payer: Hawaii Medical Service Association Medicare	$100.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.32
Rate for Payer: Hawaii Western Management Group Commercial	$190.95
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Humana Medicare	$100.50
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: Kaiser Permanente Medicaid	$102.51
Rate for Payer: Kaiser Permanente Medicare	$100.50
Rate for Payer: MDX Hawaii PPO	$194.97
Rate for Payer: Ohana Health Plan Medicaid	$100.50
Rate for Payer: Ohana Health Plan Medicare	$100.50
Rate for Payer: UnitedHealthcare Medicaid	$13.56
Rate for Payer: UnitedHealthcare Medicare	$100.50
Rate for Payer: University Health Alliance Commercial	$38.96

Bill Only AP 88302 Surg Level II

Facility

$216.00

Service Code	HCPCS 88302 TC
Hospital Charge Code	8196779
Hospital Revenue Code	310
Min. Negotiated Rate	$29.54
Max. Negotiated Rate	$209.52
Rate for Payer: AlohaCare Medicaid	$108.00
Rate for Payer: AlohaCare Medicare	$108.00
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Devoted Health Medicare	$118.80
Rate for Payer: Hawaii Medical Service Association ABD	$29.54
Rate for Payer: Hawaii Medical Service Association Medicare	$108.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.08
Rate for Payer: Hawaii Western Management Group Commercial	$205.20
Rate for Payer: Health Management Network Commercial	$183.60
Rate for Payer: Humana Medicare	$108.00
Rate for Payer: Kaiser Permanente Commercial	$194.40
Rate for Payer: Kaiser Permanente Medicaid	$110.16
Rate for Payer: Kaiser Permanente Medicare	$108.00
Rate for Payer: MDX Hawaii PPO	$209.52
Rate for Payer: Ohana Health Plan Medicaid	$108.00
Rate for Payer: Ohana Health Plan Medicare	$108.00
Rate for Payer: UnitedHealthcare Medicaid	$29.54
Rate for Payer: UnitedHealthcare Medicare	$108.00
Rate for Payer: University Health Alliance Commercial	$89.95

Bill Only AP 88302 Surg Level II

Facility

$216.00

Service Code	HCPCS 88302 TC
Hospital Charge Code	8196779
Hospital Revenue Code	310
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$209.52
Rate for Payer: Cash Price	$140.40
Rate for Payer: Health Management Network Commercial	$183.60
Rate for Payer: Kaiser Permanente Commercial	$194.40
Rate for Payer: MDX Hawaii PPO	$209.52

Bill Only AP 88304 Surg Level III

Facility

$412.00

Service Code	HCPCS 88304 TC
Hospital Charge Code	8196780
Hospital Revenue Code	310
Min. Negotiated Rate	$37.72
Max. Negotiated Rate	$399.64
Rate for Payer: AlohaCare Medicaid	$206.00
Rate for Payer: AlohaCare Medicare	$206.00
Rate for Payer: Cash Price	$267.80
Rate for Payer: Cash Price	$267.80
Rate for Payer: Devoted Health Medicare	$226.60
Rate for Payer: Hawaii Medical Service Association ABD	$38.92
Rate for Payer: Hawaii Medical Service Association Medicare	$206.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37.72
Rate for Payer: Hawaii Western Management Group Commercial	$391.40
Rate for Payer: Health Management Network Commercial	$350.20
Rate for Payer: Humana Medicare	$206.00
Rate for Payer: Kaiser Permanente Commercial	$370.80
Rate for Payer: Kaiser Permanente Medicaid	$210.12
Rate for Payer: Kaiser Permanente Medicare	$206.00
Rate for Payer: MDX Hawaii PPO	$399.64
Rate for Payer: Ohana Health Plan Medicaid	$206.00
Rate for Payer: Ohana Health Plan Medicare	$206.00
Rate for Payer: UnitedHealthcare Medicaid	$38.92
Rate for Payer: UnitedHealthcare Medicare	$206.00
Rate for Payer: University Health Alliance Commercial	$106.78

Bill Only AP 88304 Surg Level III

Facility

$412.00

Service Code	HCPCS 88304 TC
Hospital Charge Code	8196780
Hospital Revenue Code	310
Min. Negotiated Rate	$350.20
Max. Negotiated Rate	$399.64
Rate for Payer: Cash Price	$267.80
Rate for Payer: Health Management Network Commercial	$350.20
Rate for Payer: Kaiser Permanente Commercial	$370.80
Rate for Payer: MDX Hawaii PPO	$399.64

Bill Only AP 88305 Pathology Tissue

Facility

$390.00

Service Code	HCPCS 88305 TC
Hospital Charge Code	8196807
Hospital Revenue Code	310
Min. Negotiated Rate	$331.50
Max. Negotiated Rate	$378.30
Rate for Payer: Cash Price	$253.50
Rate for Payer: Health Management Network Commercial	$331.50
Rate for Payer: Kaiser Permanente Commercial	$351.00
Rate for Payer: MDX Hawaii PPO	$378.30

Bill Only AP 88305 Pathology Tissue

Facility

$390.00

Service Code	HCPCS 88305 TC
Hospital Charge Code	8196807
Hospital Revenue Code	310
Min. Negotiated Rate	$40.64
Max. Negotiated Rate	$378.30
Rate for Payer: AlohaCare Medicaid	$195.00
Rate for Payer: AlohaCare Medicare	$195.00
Rate for Payer: Cash Price	$253.50
Rate for Payer: Cash Price	$253.50
Rate for Payer: Devoted Health Medicare	$214.50
Rate for Payer: Hawaii Medical Service Association ABD	$40.64
Rate for Payer: Hawaii Medical Service Association Medicare	$195.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$49.53
Rate for Payer: Hawaii Western Management Group Commercial	$370.50
Rate for Payer: Health Management Network Commercial	$331.50
Rate for Payer: Humana Medicare	$195.00
Rate for Payer: Kaiser Permanente Commercial	$351.00
Rate for Payer: Kaiser Permanente Medicaid	$198.90
Rate for Payer: Kaiser Permanente Medicare	$195.00
Rate for Payer: MDX Hawaii PPO	$378.30
Rate for Payer: Ohana Health Plan Medicaid	$195.00
Rate for Payer: Ohana Health Plan Medicare	$195.00
Rate for Payer: UnitedHealthcare Medicaid	$40.64
Rate for Payer: UnitedHealthcare Medicare	$195.00
Rate for Payer: University Health Alliance Commercial	$139.05

Bill Only AP 88307 Surg Level V

Facility

$931.00

Service Code	HCPCS 88307 TC
Hospital Charge Code	8196783
Hospital Revenue Code	310
Min. Negotiated Rate	$81.42
Max. Negotiated Rate	$903.07
Rate for Payer: AlohaCare Medicaid	$465.50
Rate for Payer: AlohaCare Medicare	$465.50
Rate for Payer: Cash Price	$605.15
Rate for Payer: Cash Price	$605.15
Rate for Payer: Devoted Health Medicare	$512.05
Rate for Payer: Hawaii Medical Service Association ABD	$118.35
Rate for Payer: Hawaii Medical Service Association Medicare	$465.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$81.42
Rate for Payer: Hawaii Western Management Group Commercial	$884.45
Rate for Payer: Health Management Network Commercial	$791.35
Rate for Payer: Humana Medicare	$465.50
Rate for Payer: Kaiser Permanente Commercial	$837.90
Rate for Payer: Kaiser Permanente Medicaid	$474.81
Rate for Payer: Kaiser Permanente Medicare	$465.50
Rate for Payer: MDX Hawaii PPO	$903.07
Rate for Payer: Ohana Health Plan Medicaid	$465.50
Rate for Payer: Ohana Health Plan Medicare	$465.50
Rate for Payer: UnitedHealthcare Medicaid	$118.35
Rate for Payer: UnitedHealthcare Medicare	$465.50
Rate for Payer: University Health Alliance Commercial	$260.24

Bill Only AP 88307 Surg Level V

Facility

$931.00

Service Code	HCPCS 88307 TC
Hospital Charge Code	8196783
Hospital Revenue Code	310
Min. Negotiated Rate	$791.35
Max. Negotiated Rate	$903.07
Rate for Payer: Cash Price	$605.15
Rate for Payer: Health Management Network Commercial	$791.35
Rate for Payer: Kaiser Permanente Commercial	$837.90
Rate for Payer: MDX Hawaii PPO	$903.07

Bill Only AP 88309 Surg Level VI

Facility

$1,723.00

Service Code	HCPCS 88309 TC
Hospital Charge Code	8196784
Hospital Revenue Code	310
Min. Negotiated Rate	$1,464.55
Max. Negotiated Rate	$1,671.31
Rate for Payer: Cash Price	$1,119.95
Rate for Payer: Health Management Network Commercial	$1,464.55
Rate for Payer: Kaiser Permanente Commercial	$1,550.70
Rate for Payer: MDX Hawaii PPO	$1,671.31

Bill Only AP 88309 Surg Level VI

Facility

$1,723.00

Service Code	HCPCS 88309 TC
Hospital Charge Code	8196784
Hospital Revenue Code	310
Min. Negotiated Rate	$112.06
Max. Negotiated Rate	$1,671.31
Rate for Payer: AlohaCare Medicaid	$861.50
Rate for Payer: AlohaCare Medicare	$861.50
Rate for Payer: Cash Price	$1,119.95
Rate for Payer: Cash Price	$1,119.95
Rate for Payer: Devoted Health Medicare	$947.65
Rate for Payer: Hawaii Medical Service Association ABD	$165.80
Rate for Payer: Hawaii Medical Service Association Medicare	$861.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$112.06
Rate for Payer: Hawaii Western Management Group Commercial	$1,636.85
Rate for Payer: Health Management Network Commercial	$1,464.55
Rate for Payer: Humana Medicare	$861.50
Rate for Payer: Kaiser Permanente Commercial	$1,550.70
Rate for Payer: Kaiser Permanente Medicaid	$878.73
Rate for Payer: Kaiser Permanente Medicare	$861.50
Rate for Payer: MDX Hawaii PPO	$1,671.31
Rate for Payer: Ohana Health Plan Medicaid	$861.50
Rate for Payer: Ohana Health Plan Medicare	$861.50
Rate for Payer: UnitedHealthcare Medicaid	$165.80
Rate for Payer: UnitedHealthcare Medicare	$861.50
Rate for Payer: University Health Alliance Commercial	$353.96

Bill Only AP 88311 Decalcification

Facility

$87.00

Service Code	HCPCS 88311 TC
Hospital Charge Code	295360
Hospital Revenue Code	310
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$56.55
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39

Bill Only AP 88311 Decalcification

Facility

$87.00

Service Code	HCPCS 88311 TC
Hospital Charge Code	295360
Hospital Revenue Code	310
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$43.50
Rate for Payer: AlohaCare Medicare	$43.50
Rate for Payer: Cash Price	$56.55
Rate for Payer: Cash Price	$56.55
Rate for Payer: Devoted Health Medicare	$47.85
Rate for Payer: Hawaii Medical Service Association ABD	$12.61
Rate for Payer: Hawaii Medical Service Association Medicare	$43.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.27
Rate for Payer: Hawaii Western Management Group Commercial	$82.65
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$43.50
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$43.50
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$43.50
Rate for Payer: Ohana Health Plan Medicare	$43.50
Rate for Payer: UnitedHealthcare Medicaid	$12.61
Rate for Payer: UnitedHealthcare Medicare	$43.50
Rate for Payer: University Health Alliance Commercial	$12.52

Bill Only AP 88314 Histochem Stain W/Frozen

Facility

$183.00

Service Code	HCPCS 88314 TC
Hospital Charge Code	8409275
Hospital Revenue Code	310
Min. Negotiated Rate	$155.55
Max. Negotiated Rate	$177.51
Rate for Payer: Cash Price	$118.95
Rate for Payer: Health Management Network Commercial	$155.55
Rate for Payer: Kaiser Permanente Commercial	$164.70
Rate for Payer: MDX Hawaii PPO	$177.51

Bill Only AP 88314 Histochem Stain W/Frozen

Facility

$183.00

Service Code	HCPCS 88314 TC
Hospital Charge Code	8409275
Hospital Revenue Code	310
Min. Negotiated Rate	$47.86
Max. Negotiated Rate	$177.51
Rate for Payer: AlohaCare Medicaid	$91.50
Rate for Payer: AlohaCare Medicare	$91.50
Rate for Payer: Cash Price	$118.95
Rate for Payer: Cash Price	$118.95
Rate for Payer: Devoted Health Medicare	$100.65
Rate for Payer: Hawaii Medical Service Association ABD	$47.86
Rate for Payer: Hawaii Medical Service Association Medicare	$91.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$65.07
Rate for Payer: Hawaii Western Management Group Commercial	$173.85
Rate for Payer: Health Management Network Commercial	$155.55
Rate for Payer: Humana Medicare	$91.50
Rate for Payer: Kaiser Permanente Commercial	$164.70
Rate for Payer: Kaiser Permanente Medicaid	$93.33
Rate for Payer: Kaiser Permanente Medicare	$91.50
Rate for Payer: MDX Hawaii PPO	$177.51
Rate for Payer: Ohana Health Plan Medicaid	$91.50
Rate for Payer: Ohana Health Plan Medicare	$91.50
Rate for Payer: UnitedHealthcare Medicaid	$47.86
Rate for Payer: UnitedHealthcare Medicare	$91.50
Rate for Payer: University Health Alliance Commercial	$149.24

Bill Only AP 88319 Histochem Enzyme Ea

Facility

$1,723.00

Service Code	HCPCS 88319 TC
Hospital Charge Code	8409276
Hospital Revenue Code	310
Min. Negotiated Rate	$81.20
Max. Negotiated Rate	$1,671.31
Rate for Payer: AlohaCare Medicaid	$861.50
Rate for Payer: AlohaCare Medicare	$861.50
Rate for Payer: Cash Price	$1,119.95
Rate for Payer: Cash Price	$1,119.95
Rate for Payer: Devoted Health Medicare	$947.65
Rate for Payer: Hawaii Medical Service Association ABD	$81.20
Rate for Payer: Hawaii Medical Service Association Medicare	$861.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$103.70
Rate for Payer: Hawaii Western Management Group Commercial	$1,636.85
Rate for Payer: Health Management Network Commercial	$1,464.55
Rate for Payer: Humana Medicare	$861.50
Rate for Payer: Kaiser Permanente Commercial	$1,550.70
Rate for Payer: Kaiser Permanente Medicaid	$878.73
Rate for Payer: Kaiser Permanente Medicare	$861.50
Rate for Payer: MDX Hawaii PPO	$1,671.31
Rate for Payer: Ohana Health Plan Medicaid	$861.50
Rate for Payer: Ohana Health Plan Medicare	$861.50
Rate for Payer: UnitedHealthcare Medicaid	$81.20
Rate for Payer: UnitedHealthcare Medicare	$861.50
Rate for Payer: University Health Alliance Commercial	$251.78

Bill Only AP 88319 Histochem Enzyme Ea

Facility

$1,723.00

Service Code	HCPCS 88319 TC
Hospital Charge Code	8409276
Hospital Revenue Code	310
Min. Negotiated Rate	$1,464.55
Max. Negotiated Rate	$1,671.31
Rate for Payer: Cash Price	$1,119.95
Rate for Payer: Health Management Network Commercial	$1,464.55
Rate for Payer: Kaiser Permanente Commercial	$1,550.70
Rate for Payer: MDX Hawaii PPO	$1,671.31

Bill Only AP 88331 Surg Frozen Sect

Facility

$450.00

Service Code	HCPCS 88331 TC
Hospital Charge Code	8196785
Hospital Revenue Code	310
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$292.50
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Kaiser Permanente Commercial	$405.00
Rate for Payer: MDX Hawaii PPO	$436.50

Bill Only AP 88331 Surg Frozen Sect

Facility

$450.00

Service Code	HCPCS 88331 TC
Hospital Charge Code	8196785
Hospital Revenue Code	310
Min. Negotiated Rate	$15.63
Max. Negotiated Rate	$436.50
Rate for Payer: AlohaCare Medicaid	$225.00
Rate for Payer: AlohaCare Medicare	$225.00
Rate for Payer: Cash Price	$292.50
Rate for Payer: Cash Price	$292.50
Rate for Payer: Devoted Health Medicare	$247.50
Rate for Payer: Hawaii Medical Service Association ABD	$15.63
Rate for Payer: Hawaii Medical Service Association Medicare	$225.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.97
Rate for Payer: Hawaii Western Management Group Commercial	$427.50
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Humana Medicare	$225.00
Rate for Payer: Kaiser Permanente Commercial	$405.00
Rate for Payer: Kaiser Permanente Medicaid	$229.50
Rate for Payer: Kaiser Permanente Medicare	$225.00
Rate for Payer: MDX Hawaii PPO	$436.50
Rate for Payer: Ohana Health Plan Medicaid	$225.00
Rate for Payer: Ohana Health Plan Medicare	$225.00
Rate for Payer: UnitedHealthcare Medicaid	$15.63
Rate for Payer: UnitedHealthcare Medicare	$225.00
Rate for Payer: University Health Alliance Commercial	$59.74

Know your out-of-pocket cost for care.

All Charges