Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG PHOSPHORUS

Facility

$65.00

Service Code	HCPCS 84100
Hospital Charge Code	H3011046
Hospital Revenue Code	301
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$63.05
Rate for Payer: AlohaCare Medicaid	$4.74
Rate for Payer: AlohaCare Medicare	$4.74
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Devoted Health Medicare	$5.21
Rate for Payer: Hawaii Medical Service Association ABD	$6.56
Rate for Payer: Hawaii Medical Service Association Commercial	$5.92
Rate for Payer: Hawaii Medical Service Association Medicare	$4.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.89
Rate for Payer: Hawaii Western Management Group Commercial	$4.74
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Humana Medicare	$4.74
Rate for Payer: Kaiser Permanente Commercial	$40.95
Rate for Payer: Kaiser Permanente Medicaid	$33.15
Rate for Payer: Kaiser Permanente Medicare	$4.74
Rate for Payer: MDX Hawaii PPO	$63.05
Rate for Payer: Ohana Health Plan Medicaid	$5.21
Rate for Payer: Ohana Health Plan Medicare	$4.74
Rate for Payer: UnitedHealthcare Medicaid	$6.56
Rate for Payer: UnitedHealthcare Medicare	$4.74
Rate for Payer: University Health Alliance Commercial	$12.27

HCHG PHOSPHORUS

Facility

$65.00

Service Code	HCPCS 84100
Hospital Charge Code	H3011046
Hospital Revenue Code	301
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$42.25
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: MDX Hawaii PPO	$63.05

HCHG PHYSICAL PERFORMANCE TEST EA 15 MIN

Facility

$204.00

Service Code	HCPCS 97750
Hospital Charge Code	H4200314
Hospital Revenue Code	420
Min. Negotiated Rate	$19.83
Max. Negotiated Rate	$197.88
Rate for Payer: Cash Price	$132.60
Rate for Payer: Cash Price	$132.60
Rate for Payer: Hawaii Western Management Group Commercial	$193.80
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Kaiser Permanente Commercial	$128.52
Rate for Payer: Kaiser Permanente Medicaid	$104.04
Rate for Payer: MDX Hawaii PPO	$197.88
Rate for Payer: UnitedHealthcare Medicaid	$19.83
Rate for Payer: University Health Alliance Commercial	$148.70

HCHG PHYSICAL PERFORMANCE TEST EA 15 MIN

Facility

$204.00

Service Code	HCPCS 97750
Hospital Charge Code	H4200314
Hospital Revenue Code	420
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$197.88
Rate for Payer: Cash Price	$132.60
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: MDX Hawaii PPO	$197.88

HCHG PICC INSERT 2.5 WO PORT/PUMP 5YRS OR >

Facility

$3,598.00

Service Code	HCPCS 36569
Hospital Charge Code	H3610344
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,490.06
Rate for Payer: AlohaCare Medicaid	$1,859.62
Rate for Payer: AlohaCare Medicare	$1,859.62
Rate for Payer: Cash Price	$2,338.70
Rate for Payer: Cash Price	$2,338.70
Rate for Payer: Cash Price	$2,338.70
Rate for Payer: Devoted Health Medicare	$2,045.58
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	$1,859.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$3,058.30
Rate for Payer: Humana Medicare	$1,859.62
Rate for Payer: Kaiser Permanente Commercial	$2,266.74
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,859.62
Rate for Payer: MDX Hawaii PPO	$3,490.06
Rate for Payer: Ohana Health Plan Medicaid	$2,045.58
Rate for Payer: Ohana Health Plan Medicare	$1,859.62
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,859.62
Rate for Payer: University Health Alliance Commercial	$2,622.58

HCHG PICC INSERT 2.5 WO PORT/PUMP 5YRS OR >

Facility

$3,598.00

Service Code	HCPCS 36569
Hospital Charge Code	H3610344
Hospital Revenue Code	361
Min. Negotiated Rate	$3,058.30
Max. Negotiated Rate	$3,490.06
Rate for Payer: Cash Price	$2,338.70
Rate for Payer: Health Management Network Commercial	$3,058.30
Rate for Payer: MDX Hawaii PPO	$3,490.06

HCHG PINWORM EXAM

Facility

$53.00

Service Code	HCPCS 87172
Hospital Charge Code	H3060344
Hospital Revenue Code	306
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$51.41
Rate for Payer: AlohaCare Medicaid	$4.27
Rate for Payer: AlohaCare Medicare	$4.27
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Devoted Health Medicare	$4.70
Rate for Payer: Hawaii Medical Service Association ABD	$5.90
Rate for Payer: Hawaii Medical Service Association Commercial	$5.34
Rate for Payer: Hawaii Medical Service Association Medicare	$4.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.20
Rate for Payer: Hawaii Western Management Group Commercial	$4.27
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Humana Medicare	$4.27
Rate for Payer: Kaiser Permanente Commercial	$33.39
Rate for Payer: Kaiser Permanente Medicaid	$27.03
Rate for Payer: Kaiser Permanente Medicare	$4.27
Rate for Payer: MDX Hawaii PPO	$51.41
Rate for Payer: Ohana Health Plan Medicaid	$4.70
Rate for Payer: Ohana Health Plan Medicare	$4.27
Rate for Payer: UnitedHealthcare Medicaid	$5.90
Rate for Payer: UnitedHealthcare Medicare	$4.27
Rate for Payer: University Health Alliance Commercial	$11.03

HCHG PINWORM EXAM

Facility

$53.00

Service Code	HCPCS 87172
Hospital Charge Code	H3060344
Hospital Revenue Code	306
Min. Negotiated Rate	$45.05
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$34.45
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: MDX Hawaii PPO	$51.41

HCHG PLACE NEEDLE INTRAOSSEOUS INFUSION

Facility

$2,244.00

Service Code	HCPCS 36680
Hospital Charge Code	H4500492
Hospital Revenue Code	450
Min. Negotiated Rate	$1,907.40
Max. Negotiated Rate	$2,176.68
Rate for Payer: Cash Price	$1,458.60
Rate for Payer: Health Management Network Commercial	$1,907.40
Rate for Payer: MDX Hawaii PPO	$2,176.68

HCHG PLACE NEEDLE INTRAOSSEOUS INFUSION

Facility

$2,244.00

Service Code	HCPCS 36680
Hospital Charge Code	H4500492
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,833.00
Rate for Payer: AlohaCare Medicaid	$527.74
Rate for Payer: AlohaCare Medicare	$527.74
Rate for Payer: Cash Price	$1,458.60
Rate for Payer: Cash Price	$1,458.60
Rate for Payer: Cash Price	$1,458.60
Rate for Payer: Devoted Health Medicare	$580.51
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	$527.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,131.80
Rate for Payer: Health Management Network Commercial	$1,907.40
Rate for Payer: Humana Medicare	$527.74
Rate for Payer: Kaiser Permanente Commercial	$1,413.72
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$527.74
Rate for Payer: MDX Hawaii PPO	$2,176.68
Rate for Payer: Ohana Health Plan Medicaid	$580.51
Rate for Payer: Ohana Health Plan Medicare	$527.74
Rate for Payer: UnitedHealthcare Medicare	$527.74
Rate for Payer: University Health Alliance Commercial	$1,635.65

HCHG PLASMA 1 DONOR FRZ W/IN 8 HR EA UNIT

Facility

$582.00

Service Code	HCPCS P9017
Hospital Charge Code	H3900196
Hospital Revenue Code	390
Min. Negotiated Rate	$494.70
Max. Negotiated Rate	$564.54
Rate for Payer: Cash Price	$378.30
Rate for Payer: Health Management Network Commercial	$494.70
Rate for Payer: MDX Hawaii PPO	$564.54

HCHG PLASMA 1 DONOR FRZ W/IN 8 HR EA UNIT

Facility

$582.00

Service Code	HCPCS P9017
Hospital Charge Code	H3900196
Hospital Revenue Code	390
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$564.54
Rate for Payer: AlohaCare Medicaid	$99.42
Rate for Payer: AlohaCare Medicare	$99.42
Rate for Payer: Cash Price	$378.30
Rate for Payer: Cash Price	$378.30
Rate for Payer: Devoted Health Medicare	$109.36
Rate for Payer: Hawaii Medical Service Association Commercial	$124.28
Rate for Payer: Hawaii Medical Service Association Medicare	$99.42
Rate for Payer: Hawaii Western Management Group Commercial	$552.90
Rate for Payer: Health Management Network Commercial	$494.70
Rate for Payer: Humana Medicare	$99.42
Rate for Payer: Kaiser Permanente Commercial	$366.66
Rate for Payer: Kaiser Permanente Medicaid	$296.82
Rate for Payer: Kaiser Permanente Medicare	$99.42
Rate for Payer: MDX Hawaii PPO	$564.54
Rate for Payer: Ohana Health Plan Medicaid	$109.36
Rate for Payer: Ohana Health Plan Medicare	$99.42
Rate for Payer: UnitedHealthcare Medicaid	$59.50
Rate for Payer: UnitedHealthcare Medicare	$99.42
Rate for Payer: University Health Alliance Commercial	$424.22

HCHG PLASMA FRZ 8-24 HR EA UNIT

Facility

$523.00

Service Code	HCPCS P9059
Hospital Charge Code	H3900263
Hospital Revenue Code	390
Min. Negotiated Rate	$444.55
Max. Negotiated Rate	$507.31
Rate for Payer: Cash Price	$339.95
Rate for Payer: Health Management Network Commercial	$444.55
Rate for Payer: MDX Hawaii PPO	$507.31

HCHG PLASMA FRZ 8-24 HR EA UNIT

Facility

$523.00

Service Code	HCPCS P9059
Hospital Charge Code	H3900263
Hospital Revenue Code	390
Min. Negotiated Rate	$53.32
Max. Negotiated Rate	$507.31
Rate for Payer: AlohaCare Medicaid	$85.30
Rate for Payer: AlohaCare Medicare	$85.30
Rate for Payer: Cash Price	$339.95
Rate for Payer: Cash Price	$339.95
Rate for Payer: Devoted Health Medicare	$93.83
Rate for Payer: Hawaii Medical Service Association Commercial	$106.62
Rate for Payer: Hawaii Medical Service Association Medicare	$85.30
Rate for Payer: Hawaii Western Management Group Commercial	$496.85
Rate for Payer: Health Management Network Commercial	$444.55
Rate for Payer: Humana Medicare	$85.30
Rate for Payer: Kaiser Permanente Commercial	$329.49
Rate for Payer: Kaiser Permanente Medicaid	$266.73
Rate for Payer: Kaiser Permanente Medicare	$85.30
Rate for Payer: MDX Hawaii PPO	$507.31
Rate for Payer: Ohana Health Plan Medicaid	$93.83
Rate for Payer: Ohana Health Plan Medicare	$85.30
Rate for Payer: UnitedHealthcare Medicaid	$53.32
Rate for Payer: UnitedHealthcare Medicare	$85.30
Rate for Payer: University Health Alliance Commercial	$381.21

HCHG PLATELET ASSOC IGG AB

Facility

$162.00

Service Code	HCPCS 86023
Hospital Charge Code	H3020686
Hospital Revenue Code	302
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$157.14
Rate for Payer: AlohaCare Medicaid	$12.46
Rate for Payer: AlohaCare Medicare	$12.46
Rate for Payer: Cash Price	$105.30
Rate for Payer: Cash Price	$105.30
Rate for Payer: Devoted Health Medicare	$13.71
Rate for Payer: Hawaii Medical Service Association ABD	$15.20
Rate for Payer: Hawaii Medical Service Association Commercial	$15.57
Rate for Payer: Hawaii Medical Service Association Medicare	$12.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.21
Rate for Payer: Hawaii Western Management Group Commercial	$12.46
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: Humana Medicare	$12.46
Rate for Payer: Kaiser Permanente Commercial	$102.06
Rate for Payer: Kaiser Permanente Medicaid	$82.62
Rate for Payer: Kaiser Permanente Medicare	$12.46
Rate for Payer: MDX Hawaii PPO	$157.14
Rate for Payer: Ohana Health Plan Medicaid	$13.71
Rate for Payer: Ohana Health Plan Medicare	$12.46
Rate for Payer: UnitedHealthcare Medicaid	$15.20
Rate for Payer: UnitedHealthcare Medicare	$12.46
Rate for Payer: University Health Alliance Commercial	$32.19

HCHG PLATELET ASSOC IGG AB

Facility

$162.00

Service Code	HCPCS 86023
Hospital Charge Code	H3020686
Hospital Revenue Code	302
Min. Negotiated Rate	$137.70
Max. Negotiated Rate	$157.14
Rate for Payer: Cash Price	$105.30
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: MDX Hawaii PPO	$157.14

HCHG PLATELET ASSOC IGM AB

Facility

$162.00

Service Code	HCPCS 86023
Hospital Charge Code	H3020688
Hospital Revenue Code	302
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$157.14
Rate for Payer: AlohaCare Medicaid	$12.46
Rate for Payer: AlohaCare Medicare	$12.46
Rate for Payer: Cash Price	$105.30
Rate for Payer: Cash Price	$105.30
Rate for Payer: Devoted Health Medicare	$13.71
Rate for Payer: Hawaii Medical Service Association ABD	$15.20
Rate for Payer: Hawaii Medical Service Association Commercial	$15.57
Rate for Payer: Hawaii Medical Service Association Medicare	$12.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.21
Rate for Payer: Hawaii Western Management Group Commercial	$12.46
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: Humana Medicare	$12.46
Rate for Payer: Kaiser Permanente Commercial	$102.06
Rate for Payer: Kaiser Permanente Medicaid	$82.62
Rate for Payer: Kaiser Permanente Medicare	$12.46
Rate for Payer: MDX Hawaii PPO	$157.14
Rate for Payer: Ohana Health Plan Medicaid	$13.71
Rate for Payer: Ohana Health Plan Medicare	$12.46
Rate for Payer: UnitedHealthcare Medicaid	$15.20
Rate for Payer: UnitedHealthcare Medicare	$12.46
Rate for Payer: University Health Alliance Commercial	$32.19

HCHG PLATELET ASSOC IGM AB

Facility

$162.00

Service Code	HCPCS 86023
Hospital Charge Code	H3020688
Hospital Revenue Code	302
Min. Negotiated Rate	$137.70
Max. Negotiated Rate	$157.14
Rate for Payer: Cash Price	$105.30
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: MDX Hawaii PPO	$157.14

HCHG PLATELET COUNT AUTOMATED

Facility

$60.00

Service Code	HCPCS 85049
Hospital Charge Code	H3050206
Hospital Revenue Code	305
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$58.20
Rate for Payer: AlohaCare Medicaid	$4.48
Rate for Payer: AlohaCare Medicare	$4.48
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Devoted Health Medicare	$4.93
Rate for Payer: Hawaii Medical Service Association ABD	$6.25
Rate for Payer: Hawaii Medical Service Association Commercial	$5.60
Rate for Payer: Hawaii Medical Service Association Medicare	$4.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.56
Rate for Payer: Hawaii Western Management Group Commercial	$4.48
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Humana Medicare	$4.48
Rate for Payer: Kaiser Permanente Commercial	$37.80
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: Kaiser Permanente Medicare	$4.48
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: Ohana Health Plan Medicaid	$4.93
Rate for Payer: Ohana Health Plan Medicare	$4.48
Rate for Payer: UnitedHealthcare Medicaid	$6.25
Rate for Payer: UnitedHealthcare Medicare	$4.48
Rate for Payer: University Health Alliance Commercial	$11.56

HCHG PLATELET COUNT AUTOMATED

Facility

$60.00

Service Code	HCPCS 85049
Hospital Charge Code	H3050206
Hospital Revenue Code	305
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$39.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: MDX Hawaii PPO	$58.20

HCHG PLATELET PHERESIS IRRADIATED EA UNIT

Facility

$2,756.00

Service Code	HCPCS P9036
Hospital Charge Code	H3900249
Hospital Revenue Code	390
Min. Negotiated Rate	$440.74
Max. Negotiated Rate	$2,673.32
Rate for Payer: AlohaCare Medicaid	$1,097.48
Rate for Payer: AlohaCare Medicare	$1,097.48
Rate for Payer: Cash Price	$1,791.40
Rate for Payer: Cash Price	$1,791.40
Rate for Payer: Devoted Health Medicare	$1,207.23
Rate for Payer: Hawaii Medical Service Association Commercial	$1,371.85
Rate for Payer: Hawaii Medical Service Association Medicare	$1,097.48
Rate for Payer: Hawaii Western Management Group Commercial	$2,618.20
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Humana Medicare	$1,097.48
Rate for Payer: Kaiser Permanente Commercial	$1,736.28
Rate for Payer: Kaiser Permanente Medicaid	$1,405.56
Rate for Payer: Kaiser Permanente Medicare	$1,097.48
Rate for Payer: MDX Hawaii PPO	$2,673.32
Rate for Payer: Ohana Health Plan Medicaid	$1,207.23
Rate for Payer: Ohana Health Plan Medicare	$1,097.48
Rate for Payer: UnitedHealthcare Medicaid	$440.74
Rate for Payer: UnitedHealthcare Medicare	$1,097.48
Rate for Payer: University Health Alliance Commercial	$2,008.85

HCHG PLATELET PHERESIS IRRADIATED EA UNIT

Facility

$2,756.00

Service Code	HCPCS P9036
Hospital Charge Code	H3900249
Hospital Revenue Code	390
Min. Negotiated Rate	$2,342.60
Max. Negotiated Rate	$2,673.32
Rate for Payer: Cash Price	$1,791.40
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: MDX Hawaii PPO	$2,673.32

HCHG PLATELET PHERES LEUKOREDUCED EA UNIT

Facility

$2,781.00

Service Code	HCPCS P9035
Hospital Charge Code	H3900250
Hospital Revenue Code	390
Min. Negotiated Rate	$2,363.85
Max. Negotiated Rate	$2,697.57
Rate for Payer: Cash Price	$1,807.65
Rate for Payer: Health Management Network Commercial	$2,363.85
Rate for Payer: MDX Hawaii PPO	$2,697.57

HCHG PLATELET PHERES LEUKOREDUCED EA UNIT

Facility

$2,781.00

Service Code	HCPCS P9035
Hospital Charge Code	H3900250
Hospital Revenue Code	390
Min. Negotiated Rate	$580.00
Max. Negotiated Rate	$2,697.57
Rate for Payer: AlohaCare Medicaid	$591.55
Rate for Payer: AlohaCare Medicare	$591.55
Rate for Payer: Cash Price	$1,807.65
Rate for Payer: Cash Price	$1,807.65
Rate for Payer: Devoted Health Medicare	$650.71
Rate for Payer: Hawaii Medical Service Association Commercial	$739.44
Rate for Payer: Hawaii Medical Service Association Medicare	$591.55
Rate for Payer: Hawaii Western Management Group Commercial	$2,641.95
Rate for Payer: Health Management Network Commercial	$2,363.85
Rate for Payer: Humana Medicare	$591.55
Rate for Payer: Kaiser Permanente Commercial	$1,752.03
Rate for Payer: Kaiser Permanente Medicaid	$1,418.31
Rate for Payer: Kaiser Permanente Medicare	$591.55
Rate for Payer: MDX Hawaii PPO	$2,697.57
Rate for Payer: Ohana Health Plan Medicaid	$650.71
Rate for Payer: Ohana Health Plan Medicare	$591.55
Rate for Payer: UnitedHealthcare Medicaid	$580.00
Rate for Payer: UnitedHealthcare Medicare	$591.55
Rate for Payer: University Health Alliance Commercial	$2,027.07

HCHG PLATELETS, PHERESIS, EA UNIT

Facility

$2,235.00

Service Code	HCPCS P9034
Hospital Charge Code	H3900204
Hospital Revenue Code	390
Min. Negotiated Rate	$357.25
Max. Negotiated Rate	$2,167.95
Rate for Payer: AlohaCare Medicaid	$357.25
Rate for Payer: AlohaCare Medicare	$357.25
Rate for Payer: Cash Price	$1,452.75
Rate for Payer: Cash Price	$1,452.75
Rate for Payer: Devoted Health Medicare	$392.98
Rate for Payer: Hawaii Medical Service Association Commercial	$446.56
Rate for Payer: Hawaii Medical Service Association Medicare	$357.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,123.25
Rate for Payer: Health Management Network Commercial	$1,899.75
Rate for Payer: Humana Medicare	$357.25
Rate for Payer: Kaiser Permanente Commercial	$1,408.05
Rate for Payer: Kaiser Permanente Medicaid	$1,139.85
Rate for Payer: Kaiser Permanente Medicare	$357.25
Rate for Payer: MDX Hawaii PPO	$2,167.95
Rate for Payer: Ohana Health Plan Medicaid	$392.98
Rate for Payer: Ohana Health Plan Medicare	$357.25
Rate for Payer: UnitedHealthcare Medicaid	$575.00
Rate for Payer: UnitedHealthcare Medicare	$357.25
Rate for Payer: University Health Alliance Commercial	$1,629.09

Know your out-of-pocket cost for care.

All Charges