Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG PULMONARY STRESS TEST

Facility

$714.00

Service Code	HCPCS 94618
Hospital Charge Code	H4600138
Hospital Revenue Code	460
Min. Negotiated Rate	$606.90
Max. Negotiated Rate	$692.58
Rate for Payer: Cash Price	$464.10
Rate for Payer: Health Management Network Commercial	$606.90
Rate for Payer: MDX Hawaii PPO	$692.58

HCHG PULMONARY VENT AND PERFUSION IMAGING

Facility

$2,461.00

Service Code	HCPCS 78582
Hospital Charge Code	H3410378
Hospital Revenue Code	341
Min. Negotiated Rate	$188.03
Max. Negotiated Rate	$2,387.17
Rate for Payer: AlohaCare Medicaid	$641.43
Rate for Payer: AlohaCare Medicare	$641.43
Rate for Payer: Cash Price	$1,599.65
Rate for Payer: Cash Price	$1,599.65
Rate for Payer: Devoted Health Medicare	$705.57
Rate for Payer: Hawaii Medical Service Association ABD	$188.03
Rate for Payer: Hawaii Medical Service Association Commercial	$801.79
Rate for Payer: Hawaii Medical Service Association Medicare	$641.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$256.07
Rate for Payer: Hawaii Western Management Group Commercial	$641.43
Rate for Payer: Health Management Network Commercial	$2,091.85
Rate for Payer: Humana Medicare	$641.43
Rate for Payer: Kaiser Permanente Commercial	$1,550.43
Rate for Payer: Kaiser Permanente Medicaid	$1,255.11
Rate for Payer: Kaiser Permanente Medicare	$641.43
Rate for Payer: MDX Hawaii PPO	$2,387.17
Rate for Payer: Ohana Health Plan Medicaid	$705.57
Rate for Payer: Ohana Health Plan Medicare	$641.43
Rate for Payer: UnitedHealthcare Medicaid	$188.03
Rate for Payer: UnitedHealthcare Medicare	$641.43
Rate for Payer: University Health Alliance Commercial	$818.29

HCHG PULMONARY VENT AND PERFUSION IMAGING

Facility

$2,461.00

Service Code	HCPCS 78582
Hospital Charge Code	H3410378
Hospital Revenue Code	341
Min. Negotiated Rate	$2,091.85
Max. Negotiated Rate	$2,387.17
Rate for Payer: Cash Price	$1,599.65
Rate for Payer: Health Management Network Commercial	$2,091.85
Rate for Payer: MDX Hawaii PPO	$2,387.17

HCHG PUNCT ASP ABSC/HEMA/BULLA/CYST

Facility

$2,246.00

Service Code	HCPCS 10160
Hospital Charge Code	H4500590
Hospital Revenue Code	450
Min. Negotiated Rate	$1,909.10
Max. Negotiated Rate	$2,178.62
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: MDX Hawaii PPO	$2,178.62

HCHG PUNCT ASP ABSC/HEMA/BULLA/CYST

Facility

$2,246.00

Service Code	HCPCS 10160
Hospital Charge Code	H4500590
Hospital Revenue Code	450
Min. Negotiated Rate	$480.23
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Devoted Health Medicare	$528.25
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	$480.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,133.70
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$1,414.98
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$2,178.62
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST

Facility

$2,246.00

Service Code	HCPCS 10160
Hospital Charge Code	H3610633
Hospital Revenue Code	361
Min. Negotiated Rate	$1,909.10
Max. Negotiated Rate	$2,178.62
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: MDX Hawaii PPO	$2,178.62

HCHG PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST

Facility

$2,246.00

Service Code	HCPCS 10160
Hospital Charge Code	H3610633
Hospital Revenue Code	361
Min. Negotiated Rate	$57.25
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Cash Price	$1,459.90
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association Commercial	$600.29
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$1,414.98
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$2,178.62
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicaid	$57.25
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX

Facility

$3,351.00

Service Code	HCPCS 61070
Hospital Charge Code	H4501072
Hospital Revenue Code	450
Min. Negotiated Rate	$2,848.35
Max. Negotiated Rate	$3,250.47
Rate for Payer: Cash Price	$2,178.15
Rate for Payer: Health Management Network Commercial	$2,848.35
Rate for Payer: MDX Hawaii PPO	$3,250.47

HCHG PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX

Facility

$3,351.00

Service Code	HCPCS 61070
Hospital Charge Code	H4501072
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,250.47
Rate for Payer: AlohaCare Medicaid	$833.89
Rate for Payer: AlohaCare Medicare	$833.89
Rate for Payer: Cash Price	$2,178.15
Rate for Payer: Cash Price	$2,178.15
Rate for Payer: Cash Price	$2,178.15
Rate for Payer: Cash Price	$2,178.15
Rate for Payer: Devoted Health Medicare	$917.28
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	$833.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,183.45
Rate for Payer: Health Management Network Commercial	$2,848.35
Rate for Payer: Humana Medicare	$833.89
Rate for Payer: Kaiser Permanente Commercial	$2,111.13
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$833.89
Rate for Payer: MDX Hawaii PPO	$3,250.47
Rate for Payer: Ohana Health Plan Medicaid	$917.28
Rate for Payer: Ohana Health Plan Medicare	$833.89
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$833.89
Rate for Payer: University Health Alliance Commercial	$2,442.54

HCHG PYRUVATE KINASE

Facility

$116.00

Service Code	HCPCS 84220
Hospital Charge Code	H3011388
Hospital Revenue Code	301
Min. Negotiated Rate	$7.91
Max. Negotiated Rate	$112.52
Rate for Payer: AlohaCare Medicaid	$9.44
Rate for Payer: AlohaCare Medicare	$9.44
Rate for Payer: Cash Price	$75.40
Rate for Payer: Cash Price	$75.40
Rate for Payer: Devoted Health Medicare	$10.38
Rate for Payer: Hawaii Medical Service Association ABD	$7.91
Rate for Payer: Hawaii Medical Service Association Commercial	$11.80
Rate for Payer: Hawaii Medical Service Association Medicare	$9.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.03
Rate for Payer: Hawaii Western Management Group Commercial	$9.44
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: Humana Medicare	$9.44
Rate for Payer: Kaiser Permanente Commercial	$73.08
Rate for Payer: Kaiser Permanente Medicaid	$59.16
Rate for Payer: Kaiser Permanente Medicare	$9.44
Rate for Payer: MDX Hawaii PPO	$112.52
Rate for Payer: Ohana Health Plan Medicaid	$10.38
Rate for Payer: Ohana Health Plan Medicare	$9.44
Rate for Payer: UnitedHealthcare Medicaid	$7.91
Rate for Payer: UnitedHealthcare Medicare	$9.44
Rate for Payer: University Health Alliance Commercial	$24.38

HCHG PYRUVATE KINASE

Facility

$116.00

Service Code	HCPCS 84220
Hospital Charge Code	H3011388
Hospital Revenue Code	301
Min. Negotiated Rate	$98.60
Max. Negotiated Rate	$112.52
Rate for Payer: Cash Price	$75.40
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: MDX Hawaii PPO	$112.52

HCHG Q FEVER IGG PHASE II TITER

Facility

$149.00

Service Code	HCPCS 86638
Hospital Charge Code	H3020974
Hospital Revenue Code	302
Min. Negotiated Rate	$126.65
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$96.85
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: MDX Hawaii PPO	$144.53

HCHG Q FEVER IGG PHASE II TITER

Facility

$149.00

Service Code	HCPCS 86638
Hospital Charge Code	H3020974
Hospital Revenue Code	302
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$144.53
Rate for Payer: AlohaCare Medicaid	$12.12
Rate for Payer: AlohaCare Medicare	$12.12
Rate for Payer: Cash Price	$96.85
Rate for Payer: Cash Price	$96.85
Rate for Payer: Devoted Health Medicare	$13.33
Rate for Payer: Hawaii Medical Service Association ABD	$10.16
Rate for Payer: Hawaii Medical Service Association Commercial	$15.15
Rate for Payer: Hawaii Medical Service Association Medicare	$12.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.74
Rate for Payer: Hawaii Western Management Group Commercial	$12.12
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Humana Medicare	$12.12
Rate for Payer: Kaiser Permanente Commercial	$93.87
Rate for Payer: Kaiser Permanente Medicaid	$75.99
Rate for Payer: Kaiser Permanente Medicare	$12.12
Rate for Payer: MDX Hawaii PPO	$144.53
Rate for Payer: Ohana Health Plan Medicaid	$13.33
Rate for Payer: Ohana Health Plan Medicare	$12.12
Rate for Payer: UnitedHealthcare Medicaid	$10.16
Rate for Payer: UnitedHealthcare Medicare	$12.12
Rate for Payer: University Health Alliance Commercial	$31.34

HCHG Q FEVER IGG PHASE I TITER

Facility

$149.00

Service Code	HCPCS 86638
Hospital Charge Code	H3020973
Hospital Revenue Code	302
Min. Negotiated Rate	$126.65
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$96.85
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: MDX Hawaii PPO	$144.53

HCHG Q FEVER IGG PHASE I TITER

Facility

$149.00

Service Code	HCPCS 86638
Hospital Charge Code	H3020973
Hospital Revenue Code	302
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$144.53
Rate for Payer: AlohaCare Medicaid	$12.12
Rate for Payer: AlohaCare Medicare	$12.12
Rate for Payer: Cash Price	$96.85
Rate for Payer: Cash Price	$96.85
Rate for Payer: Devoted Health Medicare	$13.33
Rate for Payer: Hawaii Medical Service Association ABD	$10.16
Rate for Payer: Hawaii Medical Service Association Commercial	$15.15
Rate for Payer: Hawaii Medical Service Association Medicare	$12.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.74
Rate for Payer: Hawaii Western Management Group Commercial	$12.12
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Humana Medicare	$12.12
Rate for Payer: Kaiser Permanente Commercial	$93.87
Rate for Payer: Kaiser Permanente Medicaid	$75.99
Rate for Payer: Kaiser Permanente Medicare	$12.12
Rate for Payer: MDX Hawaii PPO	$144.53
Rate for Payer: Ohana Health Plan Medicaid	$13.33
Rate for Payer: Ohana Health Plan Medicare	$12.12
Rate for Payer: UnitedHealthcare Medicaid	$10.16
Rate for Payer: UnitedHealthcare Medicare	$12.12
Rate for Payer: University Health Alliance Commercial	$31.34

HCHG QUAD COUGH INIT

Facility

$344.00

Service Code	HCPCS 94667
Hospital Charge Code	H4100182
Hospital Revenue Code	410
Min. Negotiated Rate	$292.40
Max. Negotiated Rate	$333.68
Rate for Payer: Cash Price	$223.60
Rate for Payer: Health Management Network Commercial	$292.40
Rate for Payer: MDX Hawaii PPO	$333.68

HCHG QUAD COUGH INIT

Facility

$344.00

Service Code	HCPCS 94667
Hospital Charge Code	H4100182
Hospital Revenue Code	410
Min. Negotiated Rate	$20.34
Max. Negotiated Rate	$333.68
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$223.60
Rate for Payer: Cash Price	$223.60
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Western Management Group Commercial	$326.80
Rate for Payer: Health Management Network Commercial	$292.40
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$216.72
Rate for Payer: Kaiser Permanente Medicaid	$175.44
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$333.68
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$20.34
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$250.74

HCHG QUAD COUGH SUBSEQ

Facility

$250.00

Service Code	HCPCS 94668
Hospital Charge Code	H4100183
Hospital Revenue Code	412
Min. Negotiated Rate	$212.50
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Health Management Network Commercial	$212.50
Rate for Payer: MDX Hawaii PPO	$242.50

HCHG QUAD COUGH SUBSEQ

Facility

$250.00

Service Code	HCPCS 94668
Hospital Charge Code	H4100183
Hospital Revenue Code	412
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$242.50
Rate for Payer: AlohaCare Medicaid	$157.18
Rate for Payer: AlohaCare Medicare	$157.18
Rate for Payer: Cash Price	$162.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Devoted Health Medicare	$172.90
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$157.18
Rate for Payer: Hawaii Western Management Group Commercial	$237.50
Rate for Payer: Health Management Network Commercial	$212.50
Rate for Payer: Humana Medicare	$157.18
Rate for Payer: Kaiser Permanente Commercial	$157.50
Rate for Payer: Kaiser Permanente Medicaid	$127.50
Rate for Payer: Kaiser Permanente Medicare	$157.18
Rate for Payer: MDX Hawaii PPO	$242.50
Rate for Payer: Ohana Health Plan Medicaid	$172.90
Rate for Payer: Ohana Health Plan Medicare	$157.18
Rate for Payer: UnitedHealthcare Medicaid	$16.41
Rate for Payer: UnitedHealthcare Medicare	$157.18
Rate for Payer: University Health Alliance Commercial	$182.22

HCHG QUANTIFERON-TB GOLD

Facility

$551.00

Service Code	HCPCS 86480
Hospital Charge Code	H3020904
Hospital Revenue Code	302
Min. Negotiated Rate	$51.95
Max. Negotiated Rate	$534.47
Rate for Payer: AlohaCare Medicaid	$61.98
Rate for Payer: AlohaCare Medicare	$61.98
Rate for Payer: Cash Price	$358.15
Rate for Payer: Cash Price	$358.15
Rate for Payer: Devoted Health Medicare	$68.18
Rate for Payer: Hawaii Medical Service Association ABD	$51.95
Rate for Payer: Hawaii Medical Service Association Commercial	$77.47
Rate for Payer: Hawaii Medical Service Association Medicare	$61.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$68.87
Rate for Payer: Hawaii Western Management Group Commercial	$61.98
Rate for Payer: Health Management Network Commercial	$468.35
Rate for Payer: Humana Medicare	$61.98
Rate for Payer: Kaiser Permanente Commercial	$347.13
Rate for Payer: Kaiser Permanente Medicaid	$281.01
Rate for Payer: Kaiser Permanente Medicare	$61.98
Rate for Payer: MDX Hawaii PPO	$534.47
Rate for Payer: Ohana Health Plan Medicaid	$68.18
Rate for Payer: Ohana Health Plan Medicare	$61.98
Rate for Payer: UnitedHealthcare Medicaid	$51.95
Rate for Payer: UnitedHealthcare Medicare	$61.98
Rate for Payer: University Health Alliance Commercial	$160.19

HCHG QUANTIFERON-TB GOLD

Facility

$551.00

Service Code	HCPCS 86480
Hospital Charge Code	H3020904
Hospital Revenue Code	302
Min. Negotiated Rate	$468.35
Max. Negotiated Rate	$534.47
Rate for Payer: Cash Price	$358.15
Rate for Payer: Health Management Network Commercial	$468.35
Rate for Payer: MDX Hawaii PPO	$534.47

HCHG QUANTITATION DRUG NOS SO

Facility

$226.00

Service Code	HCPCS 80151
Hospital Charge Code	K3010002
Hospital Revenue Code	301
Min. Negotiated Rate	$192.10
Max. Negotiated Rate	$219.22
Rate for Payer: Cash Price	$146.90
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: MDX Hawaii PPO	$219.22

HCHG QUANTITATION DRUG NOS SO

Facility

$226.00

Service Code	HCPCS 80151
Hospital Charge Code	K3010002
Hospital Revenue Code	301
Min. Negotiated Rate	$11.18
Max. Negotiated Rate	$219.22
Rate for Payer: AlohaCare Medicaid	$18.64
Rate for Payer: AlohaCare Medicare	$18.64
Rate for Payer: Cash Price	$146.90
Rate for Payer: Cash Price	$146.90
Rate for Payer: Devoted Health Medicare	$20.50
Rate for Payer: Hawaii Medical Service Association ABD	$18.92
Rate for Payer: Hawaii Medical Service Association Commercial	$23.30
Rate for Payer: Hawaii Medical Service Association Medicare	$18.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.87
Rate for Payer: Hawaii Western Management Group Commercial	$18.64
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: Humana Medicare	$18.64
Rate for Payer: Kaiser Permanente Commercial	$142.38
Rate for Payer: Kaiser Permanente Medicaid	$115.26
Rate for Payer: Kaiser Permanente Medicare	$18.64
Rate for Payer: MDX Hawaii PPO	$219.22
Rate for Payer: Ohana Health Plan Medicaid	$20.50
Rate for Payer: Ohana Health Plan Medicare	$18.64
Rate for Payer: UnitedHealthcare Medicaid	$11.18
Rate for Payer: UnitedHealthcare Medicare	$18.64
Rate for Payer: University Health Alliance Commercial	$164.73

HCHG RADIOLOGICAL EXAM UPR GI TRC 2 DOUBLE CONTRAST

Facility

$1,050.00

Service Code	HCPCS 74246
Hospital Charge Code	H3200967
Hospital Revenue Code	320
Min. Negotiated Rate	$892.50
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$682.50
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: MDX Hawaii PPO	$1,018.50

HCHG RADIOLOGICAL EXAM UPR GI TRC 2 DOUBLE CONTRAST

Facility

$1,050.00

Service Code	HCPCS 74246
Hospital Charge Code	H3200967
Hospital Revenue Code	320
Min. Negotiated Rate	$54.40
Max. Negotiated Rate	$1,018.50
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$682.50
Rate for Payer: Cash Price	$682.50
Rate for Payer: Devoted Health Medicare	$227.93
Rate for Payer: Hawaii Medical Service Association ABD	$54.40
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$207.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$58.79
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: Kaiser Permanente Medicaid	$535.50
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: Ohana Health Plan Medicaid	$227.93
Rate for Payer: Ohana Health Plan Medicare	$207.21
Rate for Payer: UnitedHealthcare Medicaid	$54.40
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$237.13

Know your out-of-pocket cost for care.

All Charges