Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

CANCELLOUS SCREW, CAPTURED, PT,6.0X50MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974101
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X50MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974101
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X55MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974098
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X55MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974098
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X65MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974104
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X65MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974104
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X70MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974105
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X70MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974105
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X75MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974099
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X75MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974099
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X80MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974100
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X80MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974100
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED,PT,6.0X85MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974109
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED,PT,6.0X85MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974109
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X90MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974107
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X90MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974107
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X95MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974108
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X95MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974108
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

Cancer Antigen 27.29 FSI

Facility

$268.00

Service Code	HCPCS 86300
Hospital Charge Code	10046722
Hospital Revenue Code	302
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$259.96
Rate for Payer: AlohaCare Medicaid	$134.00
Rate for Payer: AlohaCare Medicare	$134.00
Rate for Payer: Cash Price	$174.20
Rate for Payer: Cash Price	$174.20
Rate for Payer: Devoted Health Medicare	$147.40
Rate for Payer: Hawaii Medical Service Association ABD	$28.76
Rate for Payer: Hawaii Medical Service Association Commercial	$26.01
Rate for Payer: Hawaii Medical Service Association Medicare	$134.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.20
Rate for Payer: Hawaii Western Management Group Commercial	$20.81
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: Humana Medicare	$134.00
Rate for Payer: Kaiser Permanente Commercial	$241.20
Rate for Payer: Kaiser Permanente Medicaid	$136.68
Rate for Payer: Kaiser Permanente Medicare	$134.00
Rate for Payer: MDX Hawaii PPO	$259.96
Rate for Payer: Ohana Health Plan Medicaid	$134.00
Rate for Payer: Ohana Health Plan Medicare	$134.00
Rate for Payer: UnitedHealthcare Medicaid	$28.76
Rate for Payer: UnitedHealthcare Medicare	$134.00
Rate for Payer: University Health Alliance Commercial	$53.78

Cancer Antigen 27.29 FSI

Facility

$268.00

Service Code	HCPCS 86300
Hospital Charge Code	10046722
Hospital Revenue Code	302
Min. Negotiated Rate	$227.80
Max. Negotiated Rate	$259.96
Rate for Payer: Cash Price	$174.20
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: Kaiser Permanente Commercial	$241.20
Rate for Payer: MDX Hawaii PPO	$259.96

Cancer Antigen CA 125 FSI

Facility

$237.00

Service Code	HCPCS 80156
Hospital Charge Code	8117871
Hospital Revenue Code	302
Min. Negotiated Rate	$201.45
Max. Negotiated Rate	$229.89
Rate for Payer: Cash Price	$154.05
Rate for Payer: Health Management Network Commercial	$201.45
Rate for Payer: Kaiser Permanente Commercial	$213.30
Rate for Payer: MDX Hawaii PPO	$229.89

Cancer Antigen CA 125 FSI

Facility

$237.00

Service Code	HCPCS 80156
Hospital Charge Code	8117871
Hospital Revenue Code	302
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$229.89
Rate for Payer: AlohaCare Medicaid	$118.50
Rate for Payer: AlohaCare Medicare	$118.50
Rate for Payer: Cash Price	$154.05
Rate for Payer: Cash Price	$154.05
Rate for Payer: Devoted Health Medicare	$130.35
Rate for Payer: Hawaii Medical Service Association ABD	$20.12
Rate for Payer: Hawaii Medical Service Association Commercial	$18.21
Rate for Payer: Hawaii Medical Service Association Medicare	$118.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.13
Rate for Payer: Hawaii Western Management Group Commercial	$14.57
Rate for Payer: Health Management Network Commercial	$201.45
Rate for Payer: Humana Medicare	$118.50
Rate for Payer: Kaiser Permanente Commercial	$213.30
Rate for Payer: Kaiser Permanente Medicaid	$120.87
Rate for Payer: Kaiser Permanente Medicare	$118.50
Rate for Payer: MDX Hawaii PPO	$229.89
Rate for Payer: Ohana Health Plan Medicaid	$118.50
Rate for Payer: Ohana Health Plan Medicare	$118.50
Rate for Payer: UnitedHealthcare Medicaid	$20.12
Rate for Payer: UnitedHealthcare Medicare	$118.50
Rate for Payer: University Health Alliance Commercial	$37.63

Cancer Antigen CA 19-9 FSI

Facility

$237.00

Service Code	HCPCS 86301
Hospital Charge Code	8117872
Hospital Revenue Code	302
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$229.89
Rate for Payer: AlohaCare Medicaid	$118.50
Rate for Payer: AlohaCare Medicare	$118.50
Rate for Payer: Cash Price	$154.05
Rate for Payer: Cash Price	$154.05
Rate for Payer: Devoted Health Medicare	$130.35
Rate for Payer: Hawaii Medical Service Association ABD	$28.76
Rate for Payer: Hawaii Medical Service Association Commercial	$26.01
Rate for Payer: Hawaii Medical Service Association Medicare	$118.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.20
Rate for Payer: Hawaii Western Management Group Commercial	$20.81
Rate for Payer: Health Management Network Commercial	$201.45
Rate for Payer: Humana Medicare	$118.50
Rate for Payer: Kaiser Permanente Commercial	$213.30
Rate for Payer: Kaiser Permanente Medicaid	$120.87
Rate for Payer: Kaiser Permanente Medicare	$118.50
Rate for Payer: MDX Hawaii PPO	$229.89
Rate for Payer: Ohana Health Plan Medicaid	$118.50
Rate for Payer: Ohana Health Plan Medicare	$118.50
Rate for Payer: UnitedHealthcare Medicaid	$28.76
Rate for Payer: UnitedHealthcare Medicare	$118.50
Rate for Payer: University Health Alliance Commercial	$53.78

Cancer Antigen CA 19-9 FSI

Facility

$237.00

Service Code	HCPCS 86301
Hospital Charge Code	8117872
Hospital Revenue Code	302
Min. Negotiated Rate	$201.45
Max. Negotiated Rate	$229.89
Rate for Payer: Cash Price	$154.05
Rate for Payer: Health Management Network Commercial	$201.45
Rate for Payer: Kaiser Permanente Commercial	$213.30
Rate for Payer: MDX Hawaii PPO	$229.89

Cannabinoid, Urine Screen FSI

Facility

$1,384.00

Service Code	HCPCS 80307
Hospital Charge Code	8228847
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$1,342.48
Rate for Payer: AlohaCare Medicaid	$692.00
Rate for Payer: AlohaCare Medicare	$692.00
Rate for Payer: Cash Price	$899.60
Rate for Payer: Cash Price	$899.60
Rate for Payer: Devoted Health Medicare	$761.20
Rate for Payer: Hawaii Medical Service Association ABD	$59.38
Rate for Payer: Hawaii Medical Service Association Commercial	$77.67
Rate for Payer: Hawaii Medical Service Association Medicare	$692.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.38
Rate for Payer: Hawaii Western Management Group Commercial	$62.14
Rate for Payer: Health Management Network Commercial	$1,176.40
Rate for Payer: Humana Medicare	$692.00
Rate for Payer: Kaiser Permanente Commercial	$1,245.60
Rate for Payer: Kaiser Permanente Medicaid	$705.84
Rate for Payer: Kaiser Permanente Medicare	$692.00
Rate for Payer: MDX Hawaii PPO	$1,342.48
Rate for Payer: Ohana Health Plan Medicaid	$692.00
Rate for Payer: Ohana Health Plan Medicare	$692.00
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$692.00
Rate for Payer: University Health Alliance Commercial	$147.65

Know your out-of-pocket cost for care.

All Charges