Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG DRUG CONFIRMATION

Facility

$324.00

Service Code	HCPCS G0480
Hospital Charge Code	K3010055
Hospital Revenue Code	301
Min. Negotiated Rate	$275.40
Max. Negotiated Rate	$314.28
Rate for Payer: Cash Price	$210.60
Rate for Payer: Health Management Network Commercial	$275.40
Rate for Payer: MDX Hawaii PPO	$314.28

HCHG DRUG CONFIRMATION

Facility

$324.00

Service Code	HCPCS G0480
Hospital Charge Code	K3010055
Hospital Revenue Code	301
Min. Negotiated Rate	$47.96
Max. Negotiated Rate	$314.28
Rate for Payer: AlohaCare Medicaid	$114.43
Rate for Payer: AlohaCare Medicare	$114.43
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: Devoted Health Medicare	$125.87
Rate for Payer: Hawaii Medical Service Association Commercial	$143.04
Rate for Payer: Hawaii Medical Service Association Medicare	$114.43
Rate for Payer: Hawaii Western Management Group Commercial	$307.80
Rate for Payer: Health Management Network Commercial	$275.40
Rate for Payer: Humana Medicare	$114.43
Rate for Payer: Kaiser Permanente Commercial	$204.12
Rate for Payer: Kaiser Permanente Medicaid	$165.24
Rate for Payer: Kaiser Permanente Medicare	$114.43
Rate for Payer: MDX Hawaii PPO	$314.28
Rate for Payer: Ohana Health Plan Medicaid	$125.87
Rate for Payer: Ohana Health Plan Medicare	$114.43
Rate for Payer: UnitedHealthcare Medicaid	$47.96
Rate for Payer: UnitedHealthcare Medicare	$114.43
Rate for Payer: University Health Alliance Commercial	$236.16

HCHG DRUG SCREEN AMPHETAMINES 1/2-90

Facility

$648.00

Service Code	HCPCS 80324
Hospital Charge Code	H3011787
Hospital Revenue Code	301
Min. Negotiated Rate	$550.80
Max. Negotiated Rate	$628.56
Rate for Payer: Cash Price	$421.20
Rate for Payer: Health Management Network Commercial	$550.80
Rate for Payer: MDX Hawaii PPO	$628.56

HCHG DRUG SCREEN AMPHETAMINES 1/2-90

Facility

$648.00

Service Code	HCPCS 80324
Hospital Charge Code	H3011787
Hospital Revenue Code	301
Min. Negotiated Rate	$21.48
Max. Negotiated Rate	$628.56
Rate for Payer: Cash Price	$421.20
Rate for Payer: Cash Price	$421.20
Rate for Payer: Hawaii Medical Service Association ABD	$21.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.55
Rate for Payer: Hawaii Western Management Group Commercial	$615.60
Rate for Payer: Health Management Network Commercial	$550.80
Rate for Payer: Kaiser Permanente Commercial	$408.24
Rate for Payer: Kaiser Permanente Medicaid	$330.48
Rate for Payer: MDX Hawaii PPO	$628.56
Rate for Payer: University Health Alliance Commercial	$472.33

HCHG DRUG SCREEN ANY NUMBER OF CLASSES

Facility

$119.00

Service Code	HCPCS 80305
Hospital Charge Code	K3010004
Hospital Revenue Code	301
Min. Negotiated Rate	$101.15
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$77.35
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: MDX Hawaii PPO	$115.43

HCHG DRUG SCREEN ANY NUMBER OF CLASSES

Facility

$119.00

Service Code	HCPCS 80305
Hospital Charge Code	K3010004
Hospital Revenue Code	301
Min. Negotiated Rate	$8.98
Max. Negotiated Rate	$115.43
Rate for Payer: AlohaCare Medicaid	$12.60
Rate for Payer: AlohaCare Medicare	$12.60
Rate for Payer: Cash Price	$77.35
Rate for Payer: Cash Price	$77.35
Rate for Payer: Devoted Health Medicare	$13.86
Rate for Payer: Hawaii Medical Service Association ABD	$19.03
Rate for Payer: Hawaii Medical Service Association Commercial	$15.75
Rate for Payer: Hawaii Medical Service Association Medicare	$12.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.11
Rate for Payer: Hawaii Western Management Group Commercial	$12.60
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Humana Medicare	$12.60
Rate for Payer: Kaiser Permanente Commercial	$74.97
Rate for Payer: Kaiser Permanente Medicaid	$60.69
Rate for Payer: Kaiser Permanente Medicare	$12.60
Rate for Payer: MDX Hawaii PPO	$115.43
Rate for Payer: Ohana Health Plan Medicaid	$13.86
Rate for Payer: Ohana Health Plan Medicare	$12.60
Rate for Payer: UnitedHealthcare Medicaid	$8.98
Rate for Payer: UnitedHealthcare Medicare	$12.60
Rate for Payer: University Health Alliance Commercial	$27.68

HCHG DRUG SCREEN U CORD 15 SO

Facility

$601.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010006
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$582.97
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$390.65
Rate for Payer: Cash Price	$390.65
Rate for Payer: Devoted Health Medicare	$68.35
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	$62.14
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	$510.85
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$378.63
Rate for Payer: Kaiser Permanente Medicaid	$306.51
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$582.97
Rate for Payer: Ohana Health Plan Medicaid	$68.35
Rate for Payer: Ohana Health Plan Medicare	$62.14
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$62.14
Rate for Payer: University Health Alliance Commercial	$147.65

HCHG DRUG SCREEN U CORD 15 SO

Facility

$601.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010006
Hospital Revenue Code	301
Min. Negotiated Rate	$510.85
Max. Negotiated Rate	$582.97
Rate for Payer: Cash Price	$390.65
Rate for Payer: Health Management Network Commercial	$510.85
Rate for Payer: MDX Hawaii PPO	$582.97

HCHG DRUG SCREEN U CORD 17 SO

Facility

$655.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010012
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$635.35
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$425.75
Rate for Payer: Cash Price	$425.75
Rate for Payer: Devoted Health Medicare	$68.35
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	$62.14
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	$556.75
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$412.65
Rate for Payer: Kaiser Permanente Medicaid	$334.05
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$635.35
Rate for Payer: Ohana Health Plan Medicaid	$68.35
Rate for Payer: Ohana Health Plan Medicare	$62.14
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$62.14
Rate for Payer: University Health Alliance Commercial	$147.65

HCHG DRUG SCREEN U CORD 17 SO

Facility

$655.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010012
Hospital Revenue Code	301
Min. Negotiated Rate	$556.75
Max. Negotiated Rate	$635.35
Rate for Payer: Cash Price	$425.75
Rate for Payer: Health Management Network Commercial	$556.75
Rate for Payer: MDX Hawaii PPO	$635.35

HCHG DRUG SCREEN U CORD 18 SO

Facility

$624.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010067
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$605.28
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$405.60
Rate for Payer: Cash Price	$405.60
Rate for Payer: Devoted Health Medicare	$68.35
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	$62.14
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	$530.40
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$393.12
Rate for Payer: Kaiser Permanente Medicaid	$318.24
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$605.28
Rate for Payer: Ohana Health Plan Medicaid	$68.35
Rate for Payer: Ohana Health Plan Medicare	$62.14
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$62.14
Rate for Payer: University Health Alliance Commercial	$147.65

HCHG DRUG SCREEN U CORD 18 SO

Facility

$624.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010067
Hospital Revenue Code	301
Min. Negotiated Rate	$530.40
Max. Negotiated Rate	$605.28
Rate for Payer: Cash Price	$405.60
Rate for Payer: Health Management Network Commercial	$530.40
Rate for Payer: MDX Hawaii PPO	$605.28

HCHG DRUG SCRN ALCOHOL MET SO

Facility

$767.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010008
Hospital Revenue Code	301
Min. Negotiated Rate	$651.95
Max. Negotiated Rate	$743.99
Rate for Payer: Cash Price	$498.55
Rate for Payer: Health Management Network Commercial	$651.95
Rate for Payer: MDX Hawaii PPO	$743.99

HCHG DRUG SCRN ALCOHOL MET SO

Facility

$767.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010008
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$743.99
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$498.55
Rate for Payer: Cash Price	$498.55
Rate for Payer: Devoted Health Medicare	$68.35
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	$62.14
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	$651.95
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$483.21
Rate for Payer: Kaiser Permanente Medicaid	$391.17
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$743.99
Rate for Payer: Ohana Health Plan Medicaid	$68.35
Rate for Payer: Ohana Health Plan Medicare	$62.14
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$62.14
Rate for Payer: University Health Alliance Commercial	$147.65

HCHG DRUG SCRN FENTANYL SO

Facility

$601.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010005
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$582.97
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$390.65
Rate for Payer: Cash Price	$390.65
Rate for Payer: Devoted Health Medicare	$68.35
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	$62.14
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	$510.85
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$378.63
Rate for Payer: Kaiser Permanente Medicaid	$306.51
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$582.97
Rate for Payer: Ohana Health Plan Medicaid	$68.35
Rate for Payer: Ohana Health Plan Medicare	$62.14
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$62.14
Rate for Payer: University Health Alliance Commercial	$147.65

HCHG DRUG SCRN FENTANYL SO

Facility

$601.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010005
Hospital Revenue Code	301
Min. Negotiated Rate	$510.85
Max. Negotiated Rate	$582.97
Rate for Payer: Cash Price	$390.65
Rate for Payer: Health Management Network Commercial	$510.85
Rate for Payer: MDX Hawaii PPO	$582.97

HCHG DRUG SCRN MECONIUM 14 SO

Facility

$516.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010014
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$500.52
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$335.40
Rate for Payer: Cash Price	$335.40
Rate for Payer: Devoted Health Medicare	$68.35
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	$62.14
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	$438.60
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$325.08
Rate for Payer: Kaiser Permanente Medicaid	$263.16
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$500.52
Rate for Payer: Ohana Health Plan Medicaid	$68.35
Rate for Payer: Ohana Health Plan Medicare	$62.14
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$62.14
Rate for Payer: University Health Alliance Commercial	$147.65

HCHG DRUG SCRN MECONIUM 14 SO

Facility

$516.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010014
Hospital Revenue Code	301
Min. Negotiated Rate	$438.60
Max. Negotiated Rate	$500.52
Rate for Payer: Cash Price	$335.40
Rate for Payer: Health Management Network Commercial	$438.60
Rate for Payer: MDX Hawaii PPO	$500.52

HCHG DRUG SCRN PAIN MANAGE

Facility

$688.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010016
Hospital Revenue Code	301
Min. Negotiated Rate	$584.80
Max. Negotiated Rate	$667.36
Rate for Payer: Cash Price	$447.20
Rate for Payer: Health Management Network Commercial	$584.80
Rate for Payer: MDX Hawaii PPO	$667.36

HCHG DRUG SCRN PAIN MANAGE

Facility

$688.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010016
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$667.36
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$447.20
Rate for Payer: Cash Price	$447.20
Rate for Payer: Devoted Health Medicare	$68.35
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	$62.14
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	$584.80
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$433.44
Rate for Payer: Kaiser Permanente Medicaid	$350.88
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$667.36
Rate for Payer: Ohana Health Plan Medicaid	$68.35
Rate for Payer: Ohana Health Plan Medicare	$62.14
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$62.14
Rate for Payer: University Health Alliance Commercial	$147.65

HCHG DRUG SCRN U CORD 14 SO

Facility

$663.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010015
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$643.11
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$430.95
Rate for Payer: Cash Price	$430.95
Rate for Payer: Devoted Health Medicare	$68.35
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	$62.14
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	$563.55
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$417.69
Rate for Payer: Kaiser Permanente Medicaid	$338.13
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$643.11
Rate for Payer: Ohana Health Plan Medicaid	$68.35
Rate for Payer: Ohana Health Plan Medicare	$62.14
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$62.14
Rate for Payer: University Health Alliance Commercial	$147.65

HCHG DRUG SCRN U CORD 14 SO

Facility

$663.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010015
Hospital Revenue Code	301
Min. Negotiated Rate	$563.55
Max. Negotiated Rate	$643.11
Rate for Payer: Cash Price	$430.95
Rate for Payer: Health Management Network Commercial	$563.55
Rate for Payer: MDX Hawaii PPO	$643.11

HCHG DRUG SCRN U CORD 15 ETG SO

Facility

$874.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010010
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$847.78
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$568.10
Rate for Payer: Cash Price	$568.10
Rate for Payer: Devoted Health Medicare	$68.35
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	$62.14
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	$742.90
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$550.62
Rate for Payer: Kaiser Permanente Medicaid	$445.74
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$847.78
Rate for Payer: Ohana Health Plan Medicaid	$68.35
Rate for Payer: Ohana Health Plan Medicare	$62.14
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$62.14
Rate for Payer: University Health Alliance Commercial	$147.65

HCHG DRUG SCRN U CORD 15 ETG SO

Facility

$874.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010010
Hospital Revenue Code	301
Min. Negotiated Rate	$742.90
Max. Negotiated Rate	$847.78
Rate for Payer: Cash Price	$568.10
Rate for Payer: Health Management Network Commercial	$742.90
Rate for Payer: MDX Hawaii PPO	$847.78

HCHG DRUG SCRN UCRD 17 ETG SO

Facility

$874.00

Service Code	HCPCS 80307
Hospital Charge Code	K3010013
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$847.78
Rate for Payer: AlohaCare Medicaid	$62.14
Rate for Payer: AlohaCare Medicare	$62.14
Rate for Payer: Cash Price	$568.10
Rate for Payer: Cash Price	$568.10
Rate for Payer: Devoted Health Medicare	$68.35
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	$62.14
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	$742.90
Rate for Payer: Humana Medicare	$62.14
Rate for Payer: Kaiser Permanente Commercial	$550.62
Rate for Payer: Kaiser Permanente Medicaid	$445.74
Rate for Payer: Kaiser Permanente Medicare	$62.14
Rate for Payer: MDX Hawaii PPO	$847.78
Rate for Payer: Ohana Health Plan Medicaid	$68.35
Rate for Payer: Ohana Health Plan Medicare	$62.14
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$62.14
Rate for Payer: University Health Alliance Commercial	$147.65

Know your out-of-pocket cost for care.

All Charges