Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG DILANTIN TOTAL

Facility

$163.00

Service Code	HCPCS 80185
Hospital Charge Code	H3010478
Hospital Revenue Code	301
Min. Negotiated Rate	$13.25
Max. Negotiated Rate	$158.11
Rate for Payer: AlohaCare Medicaid	$13.25
Rate for Payer: AlohaCare Medicare	$13.25
Rate for Payer: Cash Price	$105.95
Rate for Payer: Cash Price	$105.95
Rate for Payer: Devoted Health Medicare	$14.57
Rate for Payer: Hawaii Medical Service Association ABD	$18.32
Rate for Payer: Hawaii Medical Service Association Commercial	$16.56
Rate for Payer: Hawaii Medical Service Association Medicare	$13.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.24
Rate for Payer: Hawaii Western Management Group Commercial	$13.25
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Humana Medicare	$13.25
Rate for Payer: Kaiser Permanente Commercial	$102.69
Rate for Payer: Kaiser Permanente Medicaid	$83.13
Rate for Payer: Kaiser Permanente Medicare	$13.25
Rate for Payer: MDX Hawaii PPO	$158.11
Rate for Payer: Ohana Health Plan Medicaid	$14.57
Rate for Payer: Ohana Health Plan Medicare	$13.25
Rate for Payer: UnitedHealthcare Medicaid	$18.32
Rate for Payer: UnitedHealthcare Medicare	$13.25
Rate for Payer: University Health Alliance Commercial	$34.26

HCHG DILANTIN TOTAL

Facility

$163.00

Service Code	HCPCS 80185
Hospital Charge Code	H3010478
Hospital Revenue Code	301
Min. Negotiated Rate	$138.55
Max. Negotiated Rate	$158.11
Rate for Payer: Cash Price	$105.95
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: MDX Hawaii PPO	$158.11

HCHG DISACCHARIDASE ACTIVITY PANEL, TISSUE

Facility

$148.00

Service Code	HCPCS 82657
Hospital Charge Code	H3011826
Hospital Revenue Code	301
Min. Negotiated Rate	$22.17
Max. Negotiated Rate	$143.56
Rate for Payer: AlohaCare Medicaid	$22.17
Rate for Payer: AlohaCare Medicare	$22.17
Rate for Payer: Cash Price	$96.20
Rate for Payer: Cash Price	$96.20
Rate for Payer: Devoted Health Medicare	$24.39
Rate for Payer: Hawaii Medical Service Association ABD	$24.96
Rate for Payer: Hawaii Medical Service Association Commercial	$27.71
Rate for Payer: Hawaii Medical Service Association Medicare	$22.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.21
Rate for Payer: Hawaii Western Management Group Commercial	$22.17
Rate for Payer: Health Management Network Commercial	$125.80
Rate for Payer: Humana Medicare	$22.17
Rate for Payer: Kaiser Permanente Commercial	$93.24
Rate for Payer: Kaiser Permanente Medicaid	$75.48
Rate for Payer: Kaiser Permanente Medicare	$22.17
Rate for Payer: MDX Hawaii PPO	$143.56
Rate for Payer: Ohana Health Plan Medicaid	$24.39
Rate for Payer: Ohana Health Plan Medicare	$22.17
Rate for Payer: UnitedHealthcare Medicaid	$24.96
Rate for Payer: UnitedHealthcare Medicare	$22.17
Rate for Payer: University Health Alliance Commercial	$46.68

HCHG DISACCHARIDASE ACTIVITY PANEL, TISSUE

Facility

$148.00

Service Code	HCPCS 82657
Hospital Charge Code	H3011826
Hospital Revenue Code	301
Min. Negotiated Rate	$125.80
Max. Negotiated Rate	$143.56
Rate for Payer: Cash Price	$96.20
Rate for Payer: Health Management Network Commercial	$125.80
Rate for Payer: MDX Hawaii PPO	$143.56

HCHG DISLOC CLSD ELBOW NM W MANIP

Facility

$1,441.00

Service Code	HCPCS 24640
Hospital Charge Code	H4500394
Hospital Revenue Code	450
Min. Negotiated Rate	$291.40
Max. Negotiated Rate	$2,833.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Cash Price	$936.65
Rate for Payer: Cash Price	$936.65
Rate for Payer: Cash Price	$936.65
Rate for Payer: Devoted Health Medicare	$320.54
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$291.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,368.95
Rate for Payer: Health Management Network Commercial	$1,224.85
Rate for Payer: Humana Medicare	$291.40
Rate for Payer: Kaiser Permanente Commercial	$907.83
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$1,397.77
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$1,050.34

HCHG DISLOC CLSD ELBOW NM W MANIP

Facility

$1,441.00

Service Code	HCPCS 24640
Hospital Charge Code	H4500394
Hospital Revenue Code	450
Min. Negotiated Rate	$1,224.85
Max. Negotiated Rate	$1,397.77
Rate for Payer: Cash Price	$936.65
Rate for Payer: Health Management Network Commercial	$1,224.85
Rate for Payer: MDX Hawaii PPO	$1,397.77

HCHG DISLOC CLSD TOE (IP)

Facility

$1,441.00

Service Code	HCPCS 28660
Hospital Charge Code	H4500390
Hospital Revenue Code	450
Min. Negotiated Rate	$1,224.85
Max. Negotiated Rate	$1,397.77
Rate for Payer: Cash Price	$936.65
Rate for Payer: Health Management Network Commercial	$1,224.85
Rate for Payer: MDX Hawaii PPO	$1,397.77

HCHG DISLOC CLSD TOE (IP)

Facility

$1,441.00

Service Code	HCPCS 28660
Hospital Charge Code	H4500390
Hospital Revenue Code	450
Min. Negotiated Rate	$291.40
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Cash Price	$936.65
Rate for Payer: Cash Price	$936.65
Rate for Payer: Cash Price	$936.65
Rate for Payer: Cash Price	$936.65
Rate for Payer: Devoted Health Medicare	$320.54
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$291.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,368.95
Rate for Payer: Health Management Network Commercial	$1,224.85
Rate for Payer: Humana Medicare	$291.40
Rate for Payer: Kaiser Permanente Commercial	$907.83
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$1,397.77
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$1,050.34

HCHG DISSOLVE CLOT, HEART VESSEL

Facility

$1,275.00

Service Code	HCPCS 92977
Hospital Charge Code	H4500994
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,833.00
Rate for Payer: Cash Price	$828.75
Rate for Payer: Cash Price	$828.75
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,211.25
Rate for Payer: Health Management Network Commercial	$1,083.75
Rate for Payer: Kaiser Permanente Commercial	$803.25
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$1,236.75
Rate for Payer: University Health Alliance Commercial	$929.35

HCHG DISSOLVE CLOT, HEART VESSEL

Facility

$1,275.00

Service Code	HCPCS 92977
Hospital Charge Code	H4500994
Hospital Revenue Code	450
Min. Negotiated Rate	$1,083.75
Max. Negotiated Rate	$1,236.75
Rate for Payer: Cash Price	$828.75
Rate for Payer: Health Management Network Commercial	$1,083.75
Rate for Payer: MDX Hawaii PPO	$1,236.75

HCHG DLCO

Facility

$338.00

Service Code	HCPCS 94729
Hospital Charge Code	H4600106
Hospital Revenue Code	460
Min. Negotiated Rate	$287.30
Max. Negotiated Rate	$327.86
Rate for Payer: Cash Price	$219.70
Rate for Payer: Health Management Network Commercial	$287.30
Rate for Payer: MDX Hawaii PPO	$327.86

HCHG DLCO

Facility

$338.00

Service Code	HCPCS 94729
Hospital Charge Code	H4600106
Hospital Revenue Code	460
Min. Negotiated Rate	$31.25
Max. Negotiated Rate	$327.86
Rate for Payer: Cash Price	$219.70
Rate for Payer: Cash Price	$219.70
Rate for Payer: Hawaii Medical Service Association ABD	$31.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$44.88
Rate for Payer: Hawaii Western Management Group Commercial	$321.10
Rate for Payer: Health Management Network Commercial	$287.30
Rate for Payer: Kaiser Permanente Commercial	$212.94
Rate for Payer: Kaiser Permanente Medicaid	$172.38
Rate for Payer: MDX Hawaii PPO	$327.86
Rate for Payer: UnitedHealthcare Medicaid	$31.25
Rate for Payer: University Health Alliance Commercial	$246.37

HCHG DNA/RNA AMPLIFIED PROBE - 90

Facility

$422.00

Service Code	HCPCS 87150
Hospital Charge Code	H3060752
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$409.34
Rate for Payer: AlohaCare Medicaid	$35.09
Rate for Payer: AlohaCare Medicare	$35.09
Rate for Payer: Cash Price	$274.30
Rate for Payer: Cash Price	$274.30
Rate for Payer: Devoted Health Medicare	$38.60
Rate for Payer: Hawaii Medical Service Association ABD	$50.27
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$35.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$358.70
Rate for Payer: Humana Medicare	$35.09
Rate for Payer: Kaiser Permanente Commercial	$265.86
Rate for Payer: Kaiser Permanente Medicaid	$215.22
Rate for Payer: Kaiser Permanente Medicare	$35.09
Rate for Payer: MDX Hawaii PPO	$409.34
Rate for Payer: Ohana Health Plan Medicaid	$38.60
Rate for Payer: Ohana Health Plan Medicare	$35.09
Rate for Payer: UnitedHealthcare Medicaid	$50.27
Rate for Payer: UnitedHealthcare Medicare	$35.09
Rate for Payer: University Health Alliance Commercial	$91.37

HCHG DNA/RNA AMPLIFIED PROBE - 90

Facility

$422.00

Service Code	HCPCS 87150
Hospital Charge Code	H3060752
Hospital Revenue Code	306
Min. Negotiated Rate	$358.70
Max. Negotiated Rate	$409.34
Rate for Payer: Cash Price	$274.30
Rate for Payer: Health Management Network Commercial	$358.70
Rate for Payer: MDX Hawaii PPO	$409.34

HCHG DOPPLER/DUPLEX STUDY LIMITED

Facility

$1,077.00

Service Code	HCPCS 93976
Hospital Charge Code	H3200975
Hospital Revenue Code	921
Min. Negotiated Rate	$915.45
Max. Negotiated Rate	$1,044.69
Rate for Payer: Cash Price	$700.05
Rate for Payer: Health Management Network Commercial	$915.45
Rate for Payer: MDX Hawaii PPO	$1,044.69

HCHG DOPPLER/DUPLEX STUDY LIMITED

Facility

$1,077.00

Service Code	HCPCS 93976
Hospital Charge Code	H3200975
Hospital Revenue Code	921
Min. Negotiated Rate	$106.34
Max. Negotiated Rate	$1,044.69
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$700.05
Rate for Payer: Cash Price	$700.05
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$106.34
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$125.37
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.15
Rate for Payer: Health Management Network Commercial	$915.45
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$678.51
Rate for Payer: Kaiser Permanente Medicaid	$549.27
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$1,044.69
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$106.34
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$785.03

HCHG DOPPLER STUDY, COMPLETE

Facility

$1,450.00

Service Code	HCPCS 93975
Hospital Charge Code	H9210110
Hospital Revenue Code	921
Min. Negotiated Rate	$1,232.50
Max. Negotiated Rate	$1,406.50
Rate for Payer: Cash Price	$942.50
Rate for Payer: Health Management Network Commercial	$1,232.50
Rate for Payer: MDX Hawaii PPO	$1,406.50

HCHG DOPPLER STUDY, COMPLETE

Facility

$1,450.00

Service Code	HCPCS 93975
Hospital Charge Code	H9210110
Hospital Revenue Code	921
Min. Negotiated Rate	$185.92
Max. Negotiated Rate	$1,406.50
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$942.50
Rate for Payer: Cash Price	$942.50
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$185.92
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$281.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$222.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,377.50
Rate for Payer: Health Management Network Commercial	$1,232.50
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$913.50
Rate for Payer: Kaiser Permanente Medicaid	$739.50
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$1,406.50
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$185.92
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$1,056.90

HCHG DOPPLER VELOCIMETRY FETL UMB AR

Facility

$708.00

Service Code	HCPCS 76820
Hospital Charge Code	H4020256
Hospital Revenue Code	402
Min. Negotiated Rate	$51.43
Max. Negotiated Rate	$686.76
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$460.20
Rate for Payer: Cash Price	$460.20
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$51.43
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$57.07
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$446.04
Rate for Payer: Kaiser Permanente Medicaid	$361.08
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$686.76
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$51.43
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$133.24

HCHG DOPPLER VELOCIMETRY FETL UMB AR

Facility

$708.00

Service Code	HCPCS 76820
Hospital Charge Code	H4020256
Hospital Revenue Code	402
Min. Negotiated Rate	$601.80
Max. Negotiated Rate	$686.76
Rate for Payer: Cash Price	$460.20
Rate for Payer: Health Management Network Commercial	$601.80
Rate for Payer: MDX Hawaii PPO	$686.76

HCHG DPLX SCAN-AORTA IVC ILIAC CMPL

Facility

$906.00

Service Code	HCPCS 93978
Hospital Charge Code	H9210150
Hospital Revenue Code	921
Min. Negotiated Rate	$770.10
Max. Negotiated Rate	$878.82
Rate for Payer: Cash Price	$588.90
Rate for Payer: Health Management Network Commercial	$770.10
Rate for Payer: MDX Hawaii PPO	$878.82

HCHG DPLX SCAN-AORTA IVC ILIAC CMPL

Facility

$906.00

Service Code	HCPCS 93978
Hospital Charge Code	H9210150
Hospital Revenue Code	921
Min. Negotiated Rate	$130.61
Max. Negotiated Rate	$878.82
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$588.90
Rate for Payer: Cash Price	$588.90
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$130.61
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$281.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$137.74
Rate for Payer: Hawaii Western Management Group Commercial	$860.70
Rate for Payer: Health Management Network Commercial	$770.10
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$570.78
Rate for Payer: Kaiser Permanente Medicaid	$462.06
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$878.82
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$130.61
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$660.38

HCHG DPLX SCAN-AORTA IVC ILIAC-LTD

Facility

$758.00

Service Code	HCPCS 93979
Hospital Charge Code	H9210114
Hospital Revenue Code	921
Min. Negotiated Rate	$644.30
Max. Negotiated Rate	$735.26
Rate for Payer: Cash Price	$492.70
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: MDX Hawaii PPO	$735.26

HCHG DPLX SCAN-AORTA IVC ILIAC-LTD

Facility

$758.00

Service Code	HCPCS 93979
Hospital Charge Code	H9210114
Hospital Revenue Code	921
Min. Negotiated Rate	$86.67
Max. Negotiated Rate	$735.26
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$123.50
Rate for Payer: Cash Price	$492.70
Rate for Payer: Cash Price	$492.70
Rate for Payer: Devoted Health Medicare	$135.85
Rate for Payer: Hawaii Medical Service Association ABD	$86.67
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$123.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$97.82
Rate for Payer: Hawaii Western Management Group Commercial	$720.10
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: Humana Medicare	$123.50
Rate for Payer: Kaiser Permanente Commercial	$477.54
Rate for Payer: Kaiser Permanente Medicaid	$386.58
Rate for Payer: Kaiser Permanente Medicare	$123.50
Rate for Payer: MDX Hawaii PPO	$735.26
Rate for Payer: Ohana Health Plan Medicaid	$135.85
Rate for Payer: Ohana Health Plan Medicare	$123.50
Rate for Payer: UnitedHealthcare Medicaid	$86.67
Rate for Payer: UnitedHealthcare Medicare	$123.50
Rate for Payer: University Health Alliance Commercial	$552.51

HCHG DPLX SCAN-EXTREM VEINS CMPL

Facility

$1,527.00

Service Code	HCPCS 93970
Hospital Charge Code	H9210116
Hospital Revenue Code	921
Min. Negotiated Rate	$139.85
Max. Negotiated Rate	$1,481.19
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$992.55
Rate for Payer: Cash Price	$992.55
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$139.85
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$281.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$160.42
Rate for Payer: Hawaii Western Management Group Commercial	$1,450.65
Rate for Payer: Health Management Network Commercial	$1,297.95
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$962.01
Rate for Payer: Kaiser Permanente Medicaid	$778.77
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$1,481.19
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$139.85
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$1,113.03

Know your out-of-pocket cost for care.

All Charges