Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

TELESCOPING LAG SCREW, 10.5 MM X 95 MM

Facility

$1,645.00

Service Code	HCPCS C1713
Hospital Charge Code	13005005
Hospital Revenue Code	278
Min. Negotiated Rate	$822.50
Max. Negotiated Rate	$1,595.65
Rate for Payer: AlohaCare Medicaid	$822.50
Rate for Payer: AlohaCare Medicare	$822.50
Rate for Payer: Cash Price	$1,069.25
Rate for Payer: Devoted Health Medicare	$904.75
Rate for Payer: Hawaii Medical Service Association Medicare	$822.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,151.50
Rate for Payer: Health Management Network Commercial	$1,398.25
Rate for Payer: Humana Medicare	$822.50
Rate for Payer: Kaiser Permanente Commercial	$1,480.50
Rate for Payer: Kaiser Permanente Medicaid	$838.95
Rate for Payer: Kaiser Permanente Medicare	$822.50
Rate for Payer: MDX Hawaii PPO	$1,595.65
Rate for Payer: Ohana Health Plan Medicaid	$822.50
Rate for Payer: Ohana Health Plan Medicare	$822.50
Rate for Payer: UnitedHealthcare Medicare	$822.50
Rate for Payer: University Health Alliance Commercial	$921.20

TELESCOPING LAG SCREW, 10.5 MM X 95 MM

Facility

$1,645.00

Service Code	HCPCS C1713
Hospital Charge Code	13005005
Hospital Revenue Code	278
Min. Negotiated Rate	$921.20
Max. Negotiated Rate	$1,595.65
Rate for Payer: Cash Price	$1,069.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,151.50
Rate for Payer: Health Management Network Commercial	$1,398.25
Rate for Payer: Kaiser Permanente Commercial	$1,480.50
Rate for Payer: MDX Hawaii PPO	$1,595.65
Rate for Payer: University Health Alliance Commercial	$921.20

TELESCOPING LAG SCREW, LT, 10.5 X 105MM

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Charge Code	13000797
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.20
Max. Negotiated Rate	$2,735.40
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: University Health Alliance Commercial	$1,579.20

TELESCOPING LAG SCREW, LT, 10.5 X 105MM

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Charge Code	13000797
Hospital Revenue Code	278
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$2,735.40
Rate for Payer: AlohaCare Medicaid	$1,410.00
Rate for Payer: AlohaCare Medicare	$1,410.00
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Devoted Health Medicare	$1,551.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,410.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Humana Medicare	$1,410.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: Kaiser Permanente Medicaid	$1,438.20
Rate for Payer: Kaiser Permanente Medicare	$1,410.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: Ohana Health Plan Medicaid	$1,410.00
Rate for Payer: Ohana Health Plan Medicare	$1,410.00
Rate for Payer: UnitedHealthcare Medicare	$1,410.00
Rate for Payer: University Health Alliance Commercial	$1,579.20

TELESCOPING LAG SCREW, LT, 10.5 X 110MM

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Charge Code	13000798
Hospital Revenue Code	278
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$2,735.40
Rate for Payer: AlohaCare Medicaid	$1,410.00
Rate for Payer: AlohaCare Medicare	$1,410.00
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Devoted Health Medicare	$1,551.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,410.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Humana Medicare	$1,410.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: Kaiser Permanente Medicaid	$1,438.20
Rate for Payer: Kaiser Permanente Medicare	$1,410.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: Ohana Health Plan Medicaid	$1,410.00
Rate for Payer: Ohana Health Plan Medicare	$1,410.00
Rate for Payer: UnitedHealthcare Medicare	$1,410.00
Rate for Payer: University Health Alliance Commercial	$1,579.20

TELESCOPING LAG SCREW, LT, 10.5 X 110MM

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Charge Code	13000798
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.20
Max. Negotiated Rate	$2,735.40
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: University Health Alliance Commercial	$1,579.20

TELESCOPING LAG SCREW, LT, 10.5 X 115MM

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Charge Code	13001559
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.20
Max. Negotiated Rate	$2,735.40
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: University Health Alliance Commercial	$1,579.20

TELESCOPING LAG SCREW, LT, 10.5 X 115MM

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Charge Code	13001559
Hospital Revenue Code	278
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$2,735.40
Rate for Payer: AlohaCare Medicaid	$1,410.00
Rate for Payer: AlohaCare Medicare	$1,410.00
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Devoted Health Medicare	$1,551.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,410.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Humana Medicare	$1,410.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: Kaiser Permanente Medicaid	$1,438.20
Rate for Payer: Kaiser Permanente Medicare	$1,410.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: Ohana Health Plan Medicaid	$1,410.00
Rate for Payer: Ohana Health Plan Medicare	$1,410.00
Rate for Payer: UnitedHealthcare Medicare	$1,410.00
Rate for Payer: University Health Alliance Commercial	$1,579.20

TELESCOPING LAG SCREW, LT, 10.5 X 120MM

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Charge Code	13001555
Hospital Revenue Code	278
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$2,735.40
Rate for Payer: AlohaCare Medicaid	$1,410.00
Rate for Payer: AlohaCare Medicare	$1,410.00
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Devoted Health Medicare	$1,551.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,410.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Humana Medicare	$1,410.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: Kaiser Permanente Medicaid	$1,438.20
Rate for Payer: Kaiser Permanente Medicare	$1,410.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: Ohana Health Plan Medicaid	$1,410.00
Rate for Payer: Ohana Health Plan Medicare	$1,410.00
Rate for Payer: UnitedHealthcare Medicare	$1,410.00
Rate for Payer: University Health Alliance Commercial	$1,579.20

TELESCOPING LAG SCREW, LT, 10.5 X 120MM

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Charge Code	13001555
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.20
Max. Negotiated Rate	$2,735.40
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: University Health Alliance Commercial	$1,579.20

TELESCOPING LAG SCREW, LT, 10.5 X 125MM

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Charge Code	13001557
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.20
Max. Negotiated Rate	$2,735.40
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: University Health Alliance Commercial	$1,579.20

TELESCOPING LAG SCREW, LT, 10.5 X 125MM

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Charge Code	13001557
Hospital Revenue Code	278
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$2,735.40
Rate for Payer: AlohaCare Medicaid	$1,410.00
Rate for Payer: AlohaCare Medicare	$1,410.00
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Devoted Health Medicare	$1,551.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,410.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Humana Medicare	$1,410.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: Kaiser Permanente Medicaid	$1,438.20
Rate for Payer: Kaiser Permanente Medicare	$1,410.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: Ohana Health Plan Medicaid	$1,410.00
Rate for Payer: Ohana Health Plan Medicare	$1,410.00
Rate for Payer: UnitedHealthcare Medicare	$1,410.00
Rate for Payer: University Health Alliance Commercial	$1,579.20

TELESCOPING LAG SCREW, LT, 10.5 X 80MM

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Charge Code	13001556
Hospital Revenue Code	278
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$2,735.40
Rate for Payer: AlohaCare Medicaid	$1,410.00
Rate for Payer: AlohaCare Medicare	$1,410.00
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Devoted Health Medicare	$1,551.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,410.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Humana Medicare	$1,410.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: Kaiser Permanente Medicaid	$1,438.20
Rate for Payer: Kaiser Permanente Medicare	$1,410.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: Ohana Health Plan Medicaid	$1,410.00
Rate for Payer: Ohana Health Plan Medicare	$1,410.00
Rate for Payer: UnitedHealthcare Medicare	$1,410.00
Rate for Payer: University Health Alliance Commercial	$1,579.20

TELESCOPING LAG SCREW, LT, 10.5 X 80MM

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Charge Code	13001556
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.20
Max. Negotiated Rate	$2,735.40
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: University Health Alliance Commercial	$1,579.20

TELESCOPING LAG SCREW, LT, 10.5 X 85MM

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Charge Code	13001558
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.20
Max. Negotiated Rate	$2,735.40
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: University Health Alliance Commercial	$1,579.20

TELESCOPING LAG SCREW, LT, 10.5 X 85MM

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Charge Code	13001558
Hospital Revenue Code	278
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$2,735.40
Rate for Payer: AlohaCare Medicaid	$1,410.00
Rate for Payer: AlohaCare Medicare	$1,410.00
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Devoted Health Medicare	$1,551.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,410.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Humana Medicare	$1,410.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: Kaiser Permanente Medicaid	$1,438.20
Rate for Payer: Kaiser Permanente Medicare	$1,410.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: Ohana Health Plan Medicaid	$1,410.00
Rate for Payer: Ohana Health Plan Medicare	$1,410.00
Rate for Payer: UnitedHealthcare Medicare	$1,410.00
Rate for Payer: University Health Alliance Commercial	$1,579.20

TELESCOPING LAG SCREW, LT, 10.5 X 90MM

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Charge Code	13001562
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.20
Max. Negotiated Rate	$2,735.40
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: University Health Alliance Commercial	$1,579.20

TELESCOPING LAG SCREW, LT, 10.5 X 90MM

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Charge Code	13001562
Hospital Revenue Code	278
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$2,735.40
Rate for Payer: AlohaCare Medicaid	$1,410.00
Rate for Payer: AlohaCare Medicare	$1,410.00
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Devoted Health Medicare	$1,551.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,410.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Humana Medicare	$1,410.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: Kaiser Permanente Medicaid	$1,438.20
Rate for Payer: Kaiser Permanente Medicare	$1,410.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: Ohana Health Plan Medicaid	$1,410.00
Rate for Payer: Ohana Health Plan Medicare	$1,410.00
Rate for Payer: UnitedHealthcare Medicare	$1,410.00
Rate for Payer: University Health Alliance Commercial	$1,579.20

temazepam 15 mg capsule [HHSC]

Facility

$5.44

Service Code	NDC 50268077915
Hospital Charge Code	2500807
Hospital Revenue Code	250
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$5.28
Rate for Payer: AlohaCare Medicaid	$2.72
Rate for Payer: AlohaCare Medicare	$2.72
Rate for Payer: Cash Price	$3.54
Rate for Payer: Devoted Health Medicare	$2.99
Rate for Payer: Hawaii Medical Service Association Medicare	$2.72
Rate for Payer: Hawaii Western Management Group Commercial	$5.17
Rate for Payer: Health Management Network Commercial	$4.62
Rate for Payer: Humana Medicare	$2.72
Rate for Payer: Kaiser Permanente Commercial	$4.90
Rate for Payer: Kaiser Permanente Medicaid	$2.77
Rate for Payer: Kaiser Permanente Medicare	$2.72
Rate for Payer: MDX Hawaii PPO	$5.28
Rate for Payer: Ohana Health Plan Medicaid	$2.72
Rate for Payer: Ohana Health Plan Medicare	$2.72
Rate for Payer: UnitedHealthcare Medicaid	$3.26
Rate for Payer: UnitedHealthcare Medicare	$2.72
Rate for Payer: University Health Alliance Commercial	$3.97

temazepam 15 mg capsule [HHSC]

Facility

$4.20

Service Code	NDC 65162055610
Hospital Charge Code	2500807
Hospital Revenue Code	250
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$4.07
Rate for Payer: Cash Price	$2.73
Rate for Payer: Health Management Network Commercial	$3.57
Rate for Payer: Kaiser Permanente Commercial	$3.78
Rate for Payer: MDX Hawaii PPO	$4.07

temazepam 15 mg capsule [HHSC]

Facility

$3.97

Service Code	NDC 51079041820
Hospital Charge Code	2500807
Hospital Revenue Code	250
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$3.85
Rate for Payer: AlohaCare Medicaid	$1.99
Rate for Payer: AlohaCare Medicare	$1.99
Rate for Payer: Cash Price	$2.58
Rate for Payer: Devoted Health Medicare	$2.18
Rate for Payer: Hawaii Medical Service Association Medicare	$1.99
Rate for Payer: Hawaii Western Management Group Commercial	$3.77
Rate for Payer: Health Management Network Commercial	$3.37
Rate for Payer: Humana Medicare	$1.99
Rate for Payer: Kaiser Permanente Commercial	$3.57
Rate for Payer: Kaiser Permanente Medicaid	$2.02
Rate for Payer: Kaiser Permanente Medicare	$1.99
Rate for Payer: MDX Hawaii PPO	$3.85
Rate for Payer: Ohana Health Plan Medicaid	$1.99
Rate for Payer: Ohana Health Plan Medicare	$1.99
Rate for Payer: UnitedHealthcare Medicaid	$2.38
Rate for Payer: UnitedHealthcare Medicare	$1.99
Rate for Payer: University Health Alliance Commercial	$2.89

temazepam 15 mg capsule [HHSC]

Facility

$4.20

Service Code	NDC 65162055610
Hospital Charge Code	2500807
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.07
Rate for Payer: AlohaCare Medicaid	$2.10
Rate for Payer: AlohaCare Medicare	$2.10
Rate for Payer: Cash Price	$2.73
Rate for Payer: Devoted Health Medicare	$2.31
Rate for Payer: Hawaii Medical Service Association Medicare	$2.10
Rate for Payer: Hawaii Western Management Group Commercial	$3.99
Rate for Payer: Health Management Network Commercial	$3.57
Rate for Payer: Humana Medicare	$2.10
Rate for Payer: Kaiser Permanente Commercial	$3.78
Rate for Payer: Kaiser Permanente Medicaid	$2.14
Rate for Payer: Kaiser Permanente Medicare	$2.10
Rate for Payer: MDX Hawaii PPO	$4.07
Rate for Payer: Ohana Health Plan Medicaid	$2.10
Rate for Payer: Ohana Health Plan Medicare	$2.10
Rate for Payer: UnitedHealthcare Medicaid	$2.52
Rate for Payer: UnitedHealthcare Medicare	$2.10
Rate for Payer: University Health Alliance Commercial	$3.06

temazepam 15 mg capsule [HHSC]

Facility

$4.53

Service Code	NDC 67877014601
Hospital Charge Code	2500807
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$4.39
Rate for Payer: Cash Price	$2.94
Rate for Payer: Health Management Network Commercial	$3.85
Rate for Payer: Kaiser Permanente Commercial	$4.08
Rate for Payer: MDX Hawaii PPO	$4.39

temazepam 15 mg capsule [HHSC]

Facility

$3.97

Service Code	NDC 51079041820
Hospital Charge Code	2500807
Hospital Revenue Code	250
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.85
Rate for Payer: Cash Price	$2.58
Rate for Payer: Health Management Network Commercial	$3.37
Rate for Payer: Kaiser Permanente Commercial	$3.57
Rate for Payer: MDX Hawaii PPO	$3.85

temazepam 15 mg capsule [HHSC]

Facility

$4.53

Service Code	NDC 67877014601
Hospital Charge Code	2500807
Hospital Revenue Code	250
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$4.39
Rate for Payer: AlohaCare Medicaid	$2.27
Rate for Payer: AlohaCare Medicare	$2.27
Rate for Payer: Cash Price	$2.94
Rate for Payer: Devoted Health Medicare	$2.49
Rate for Payer: Hawaii Medical Service Association Medicare	$2.27
Rate for Payer: Hawaii Western Management Group Commercial	$4.30
Rate for Payer: Health Management Network Commercial	$3.85
Rate for Payer: Humana Medicare	$2.27
Rate for Payer: Kaiser Permanente Commercial	$4.08
Rate for Payer: Kaiser Permanente Medicaid	$2.31
Rate for Payer: Kaiser Permanente Medicare	$2.27
Rate for Payer: MDX Hawaii PPO	$4.39
Rate for Payer: Ohana Health Plan Medicaid	$2.27
Rate for Payer: Ohana Health Plan Medicare	$2.27
Rate for Payer: UnitedHealthcare Medicaid	$2.72
Rate for Payer: UnitedHealthcare Medicare	$2.27
Rate for Payer: University Health Alliance Commercial	$3.30

Know your out-of-pocket cost for care.

All Charges