Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

Bill Only ANA Titer

Facility

$160.00

Service Code	HCPCS 86039
Hospital Charge Code	8301477
Hospital Revenue Code	302
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$104.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Kaiser Permanente Commercial	$144.00
Rate for Payer: MDX Hawaii PPO	$155.20

Bill Only Antigen Typing by BBH

Facility

$437.00

Service Code	HCPCS 86905
Hospital Charge Code	8301470
Hospital Revenue Code	300
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$423.89
Rate for Payer: AlohaCare Medicaid	$218.50
Rate for Payer: AlohaCare Medicare	$218.50
Rate for Payer: Cash Price	$284.05
Rate for Payer: Cash Price	$284.05
Rate for Payer: Devoted Health Medicare	$240.35
Rate for Payer: Hawaii Medical Service Association ABD	$5.28
Rate for Payer: Hawaii Medical Service Association Commercial	$4.79
Rate for Payer: Hawaii Medical Service Association Medicare	$218.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.54
Rate for Payer: Hawaii Western Management Group Commercial	$3.83
Rate for Payer: Health Management Network Commercial	$371.45
Rate for Payer: Humana Medicare	$218.50
Rate for Payer: Kaiser Permanente Commercial	$393.30
Rate for Payer: Kaiser Permanente Medicaid	$222.87
Rate for Payer: Kaiser Permanente Medicare	$218.50
Rate for Payer: MDX Hawaii PPO	$423.89
Rate for Payer: Ohana Health Plan Medicaid	$218.50
Rate for Payer: Ohana Health Plan Medicare	$218.50
Rate for Payer: UnitedHealthcare Medicaid	$5.28
Rate for Payer: UnitedHealthcare Medicare	$218.50
Rate for Payer: University Health Alliance Commercial	$9.88

Bill Only Antigen Typing by BBH

Facility

$437.00

Service Code	HCPCS 86905
Hospital Charge Code	8301470
Hospital Revenue Code	300
Min. Negotiated Rate	$371.45
Max. Negotiated Rate	$423.89
Rate for Payer: Cash Price	$284.05
Rate for Payer: Health Management Network Commercial	$371.45
Rate for Payer: Kaiser Permanente Commercial	$393.30
Rate for Payer: MDX Hawaii PPO	$423.89

Bill Only Anti Smith FSI

Facility

$205.00

Service Code	HCPCS 86235
Hospital Charge Code	8418339
Hospital Revenue Code	302
Min. Negotiated Rate	$174.25
Max. Negotiated Rate	$198.85
Rate for Payer: Cash Price	$133.25
Rate for Payer: Health Management Network Commercial	$174.25
Rate for Payer: Kaiser Permanente Commercial	$184.50
Rate for Payer: MDX Hawaii PPO	$198.85

Bill Only Anti Smith FSI

Facility

$205.00

Service Code	HCPCS 86235
Hospital Charge Code	8418339
Hospital Revenue Code	302
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$198.85
Rate for Payer: AlohaCare Medicaid	$102.50
Rate for Payer: AlohaCare Medicare	$102.50
Rate for Payer: Cash Price	$133.25
Rate for Payer: Cash Price	$133.25
Rate for Payer: Devoted Health Medicare	$112.75
Rate for Payer: Hawaii Medical Service Association ABD	$24.78
Rate for Payer: Hawaii Medical Service Association Commercial	$22.41
Rate for Payer: Hawaii Medical Service Association Medicare	$102.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.02
Rate for Payer: Hawaii Western Management Group Commercial	$17.93
Rate for Payer: Health Management Network Commercial	$174.25
Rate for Payer: Humana Medicare	$102.50
Rate for Payer: Kaiser Permanente Commercial	$184.50
Rate for Payer: Kaiser Permanente Medicaid	$104.55
Rate for Payer: Kaiser Permanente Medicare	$102.50
Rate for Payer: MDX Hawaii PPO	$198.85
Rate for Payer: Ohana Health Plan Medicaid	$102.50
Rate for Payer: Ohana Health Plan Medicare	$102.50
Rate for Payer: UnitedHealthcare Medicaid	$24.78
Rate for Payer: UnitedHealthcare Medicare	$102.50
Rate for Payer: University Health Alliance Commercial	$46.36

Bill Only AP 88104 Cyto Fluid Wash/Brush

Facility

$245.00

Service Code	HCPCS 88104 TC
Hospital Charge Code	8196798
Hospital Revenue Code	311
Min. Negotiated Rate	$20.15
Max. Negotiated Rate	$237.65
Rate for Payer: AlohaCare Medicaid	$122.50
Rate for Payer: AlohaCare Medicare	$122.50
Rate for Payer: Cash Price	$159.25
Rate for Payer: Cash Price	$159.25
Rate for Payer: Devoted Health Medicare	$134.75
Rate for Payer: Hawaii Medical Service Association ABD	$35.00
Rate for Payer: Hawaii Medical Service Association Medicare	$122.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.15
Rate for Payer: Hawaii Western Management Group Commercial	$232.75
Rate for Payer: Health Management Network Commercial	$208.25
Rate for Payer: Humana Medicare	$122.50
Rate for Payer: Kaiser Permanente Commercial	$220.50
Rate for Payer: Kaiser Permanente Medicaid	$124.95
Rate for Payer: Kaiser Permanente Medicare	$122.50
Rate for Payer: MDX Hawaii PPO	$237.65
Rate for Payer: Ohana Health Plan Medicaid	$122.50
Rate for Payer: Ohana Health Plan Medicare	$122.50
Rate for Payer: UnitedHealthcare Medicaid	$35.00
Rate for Payer: UnitedHealthcare Medicare	$122.50
Rate for Payer: University Health Alliance Commercial	$66.71

Bill Only AP 88104 Cyto Fluid Wash/Brush

Facility

$245.00

Service Code	HCPCS 88104 TC
Hospital Charge Code	8196798
Hospital Revenue Code	311
Min. Negotiated Rate	$208.25
Max. Negotiated Rate	$237.65
Rate for Payer: Cash Price	$159.25
Rate for Payer: Health Management Network Commercial	$208.25
Rate for Payer: Kaiser Permanente Commercial	$220.50
Rate for Payer: MDX Hawaii PPO	$237.65

Bill Only AP 88108 Cyto Concentration

Facility

$279.00

Service Code	HCPCS 88108 TC
Hospital Charge Code	8196794
Hospital Revenue Code	311
Min. Negotiated Rate	$237.15
Max. Negotiated Rate	$270.63
Rate for Payer: Cash Price	$181.35
Rate for Payer: Health Management Network Commercial	$237.15
Rate for Payer: Kaiser Permanente Commercial	$251.10
Rate for Payer: MDX Hawaii PPO	$270.63

Bill Only AP 88108 Cyto Concentration

Facility

$279.00

Service Code	HCPCS 88108 TC
Hospital Charge Code	8196794
Hospital Revenue Code	311
Min. Negotiated Rate	$31.77
Max. Negotiated Rate	$270.63
Rate for Payer: AlohaCare Medicaid	$139.50
Rate for Payer: AlohaCare Medicare	$139.50
Rate for Payer: Cash Price	$181.35
Rate for Payer: Cash Price	$181.35
Rate for Payer: Devoted Health Medicare	$153.45
Rate for Payer: Hawaii Medical Service Association ABD	$44.09
Rate for Payer: Hawaii Medical Service Association Medicare	$139.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$31.77
Rate for Payer: Hawaii Western Management Group Commercial	$265.05
Rate for Payer: Health Management Network Commercial	$237.15
Rate for Payer: Humana Medicare	$139.50
Rate for Payer: Kaiser Permanente Commercial	$251.10
Rate for Payer: Kaiser Permanente Medicaid	$142.29
Rate for Payer: Kaiser Permanente Medicare	$139.50
Rate for Payer: MDX Hawaii PPO	$270.63
Rate for Payer: Ohana Health Plan Medicaid	$139.50
Rate for Payer: Ohana Health Plan Medicare	$139.50
Rate for Payer: UnitedHealthcare Medicaid	$44.09
Rate for Payer: UnitedHealthcare Medicare	$139.50
Rate for Payer: University Health Alliance Commercial	$92.35

Bill Only AP 88112 Cyto Fluid

Facility

$412.00

Service Code	HCPCS 88112 TC
Hospital Charge Code	8196806
Hospital Revenue Code	311
Min. Negotiated Rate	$350.20
Max. Negotiated Rate	$399.64
Rate for Payer: Cash Price	$267.80
Rate for Payer: Health Management Network Commercial	$350.20
Rate for Payer: Kaiser Permanente Commercial	$370.80
Rate for Payer: MDX Hawaii PPO	$399.64

Bill Only AP 88112 Cyto Fluid

Facility

$412.00

Service Code	HCPCS 88112 TC
Hospital Charge Code	8196806
Hospital Revenue Code	311
Min. Negotiated Rate	$44.86
Max. Negotiated Rate	$399.64
Rate for Payer: AlohaCare Medicaid	$206.00
Rate for Payer: AlohaCare Medicare	$206.00
Rate for Payer: Cash Price	$267.80
Rate for Payer: Cash Price	$267.80
Rate for Payer: Devoted Health Medicare	$226.60
Rate for Payer: Hawaii Medical Service Association ABD	$44.86
Rate for Payer: Hawaii Medical Service Association Medicare	$206.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$47.57
Rate for Payer: Hawaii Western Management Group Commercial	$391.40
Rate for Payer: Health Management Network Commercial	$350.20
Rate for Payer: Humana Medicare	$206.00
Rate for Payer: Kaiser Permanente Commercial	$370.80
Rate for Payer: Kaiser Permanente Medicaid	$210.12
Rate for Payer: Kaiser Permanente Medicare	$206.00
Rate for Payer: MDX Hawaii PPO	$399.64
Rate for Payer: Ohana Health Plan Medicaid	$206.00
Rate for Payer: Ohana Health Plan Medicare	$206.00
Rate for Payer: UnitedHealthcare Medicaid	$44.86
Rate for Payer: UnitedHealthcare Medicare	$206.00
Rate for Payer: University Health Alliance Commercial	$106.78

Bill Only AP 88142 Cyto Gyn Liquid Prep

Facility

$231.00

Service Code	HCPCS 88142
Hospital Charge Code	8196792
Hospital Revenue Code	311
Min. Negotiated Rate	$196.35
Max. Negotiated Rate	$224.07
Rate for Payer: Cash Price	$150.15
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: MDX Hawaii PPO	$224.07

Bill Only AP 88142 Cyto Gyn Liquid Prep

Facility

$231.00

Service Code	HCPCS 88142
Hospital Charge Code	8196792
Hospital Revenue Code	311
Min. Negotiated Rate	$20.26
Max. Negotiated Rate	$224.07
Rate for Payer: AlohaCare Medicaid	$115.50
Rate for Payer: AlohaCare Medicare	$115.50
Rate for Payer: Cash Price	$150.15
Rate for Payer: Cash Price	$150.15
Rate for Payer: Devoted Health Medicare	$127.05
Rate for Payer: Hawaii Medical Service Association ABD	$28.00
Rate for Payer: Hawaii Medical Service Association Commercial	$25.32
Rate for Payer: Hawaii Medical Service Association Medicare	$115.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$29.40
Rate for Payer: Hawaii Western Management Group Commercial	$20.26
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Humana Medicare	$115.50
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: Kaiser Permanente Medicaid	$117.81
Rate for Payer: Kaiser Permanente Medicare	$115.50
Rate for Payer: MDX Hawaii PPO	$224.07
Rate for Payer: Ohana Health Plan Medicaid	$115.50
Rate for Payer: Ohana Health Plan Medicare	$115.50
Rate for Payer: UnitedHealthcare Medicaid	$28.00
Rate for Payer: UnitedHealthcare Medicare	$115.50
Rate for Payer: University Health Alliance Commercial	$52.37

Bill Only AP 88172 Cyto FNA Immed Read

Facility

$450.00

Service Code	HCPCS 88172 TC
Hospital Charge Code	8196791
Hospital Revenue Code	311
Min. Negotiated Rate	$22.64
Max. Negotiated Rate	$436.50
Rate for Payer: AlohaCare Medicaid	$225.00
Rate for Payer: AlohaCare Medicare	$225.00
Rate for Payer: Cash Price	$292.50
Rate for Payer: Cash Price	$292.50
Rate for Payer: Devoted Health Medicare	$247.50
Rate for Payer: Hawaii Medical Service Association ABD	$39.40
Rate for Payer: Hawaii Medical Service Association Medicare	$225.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.64
Rate for Payer: Hawaii Western Management Group Commercial	$427.50
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Humana Medicare	$225.00
Rate for Payer: Kaiser Permanente Commercial	$405.00
Rate for Payer: Kaiser Permanente Medicaid	$229.50
Rate for Payer: Kaiser Permanente Medicare	$225.00
Rate for Payer: MDX Hawaii PPO	$436.50
Rate for Payer: Ohana Health Plan Medicaid	$225.00
Rate for Payer: Ohana Health Plan Medicare	$225.00
Rate for Payer: UnitedHealthcare Medicaid	$39.40
Rate for Payer: UnitedHealthcare Medicare	$225.00
Rate for Payer: University Health Alliance Commercial	$45.08

Bill Only AP 88172 Cyto FNA Immed Read

Facility

$450.00

Service Code	HCPCS 88172 TC
Hospital Charge Code	8196791
Hospital Revenue Code	311
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$292.50
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Kaiser Permanente Commercial	$405.00
Rate for Payer: MDX Hawaii PPO	$436.50

Bill Only AP 88173 Cyto FNA Interp

Facility

$412.00

Service Code	HCPCS 88173 TC
Hospital Charge Code	8196790
Hospital Revenue Code	311
Min. Negotiated Rate	$50.48
Max. Negotiated Rate	$399.64
Rate for Payer: AlohaCare Medicaid	$206.00
Rate for Payer: AlohaCare Medicare	$206.00
Rate for Payer: Cash Price	$267.80
Rate for Payer: Cash Price	$267.80
Rate for Payer: Devoted Health Medicare	$226.60
Rate for Payer: Hawaii Medical Service Association ABD	$87.10
Rate for Payer: Hawaii Medical Service Association Medicare	$206.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.48
Rate for Payer: Hawaii Western Management Group Commercial	$391.40
Rate for Payer: Health Management Network Commercial	$350.20
Rate for Payer: Humana Medicare	$206.00
Rate for Payer: Kaiser Permanente Commercial	$370.80
Rate for Payer: Kaiser Permanente Medicaid	$210.12
Rate for Payer: Kaiser Permanente Medicare	$206.00
Rate for Payer: MDX Hawaii PPO	$399.64
Rate for Payer: Ohana Health Plan Medicaid	$206.00
Rate for Payer: Ohana Health Plan Medicare	$206.00
Rate for Payer: UnitedHealthcare Medicaid	$87.10
Rate for Payer: UnitedHealthcare Medicare	$206.00
Rate for Payer: University Health Alliance Commercial	$135.62

Bill Only AP 88173 Cyto FNA Interp

Facility

$412.00

Service Code	HCPCS 88173 TC
Hospital Charge Code	8196790
Hospital Revenue Code	311
Min. Negotiated Rate	$350.20
Max. Negotiated Rate	$399.64
Rate for Payer: Cash Price	$267.80
Rate for Payer: Health Management Network Commercial	$350.20
Rate for Payer: Kaiser Permanente Commercial	$370.80
Rate for Payer: MDX Hawaii PPO	$399.64

Bill Only AP 88175 Thin Prep Pap

Facility

$316.00

Service Code	HCPCS 88175
Hospital Charge Code	8264980
Hospital Revenue Code	311
Min. Negotiated Rate	$26.61
Max. Negotiated Rate	$306.52
Rate for Payer: AlohaCare Medicaid	$158.00
Rate for Payer: AlohaCare Medicare	$158.00
Rate for Payer: Cash Price	$205.40
Rate for Payer: Cash Price	$205.40
Rate for Payer: Devoted Health Medicare	$173.80
Rate for Payer: Hawaii Medical Service Association ABD	$37.01
Rate for Payer: Hawaii Medical Service Association Commercial	$33.26
Rate for Payer: Hawaii Medical Service Association Medicare	$158.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.96
Rate for Payer: Hawaii Western Management Group Commercial	$26.61
Rate for Payer: Health Management Network Commercial	$268.60
Rate for Payer: Humana Medicare	$158.00
Rate for Payer: Kaiser Permanente Commercial	$284.40
Rate for Payer: Kaiser Permanente Medicaid	$161.16
Rate for Payer: Kaiser Permanente Medicare	$158.00
Rate for Payer: MDX Hawaii PPO	$306.52
Rate for Payer: Ohana Health Plan Medicaid	$158.00
Rate for Payer: Ohana Health Plan Medicare	$158.00
Rate for Payer: UnitedHealthcare Medicaid	$37.01
Rate for Payer: UnitedHealthcare Medicare	$158.00
Rate for Payer: University Health Alliance Commercial	$68.47

Bill Only AP 88175 Thin Prep Pap

Facility

$316.00

Service Code	HCPCS 88175
Hospital Charge Code	8264980
Hospital Revenue Code	311
Min. Negotiated Rate	$268.60
Max. Negotiated Rate	$306.52
Rate for Payer: Cash Price	$205.40
Rate for Payer: Health Management Network Commercial	$268.60
Rate for Payer: Kaiser Permanente Commercial	$284.40
Rate for Payer: MDX Hawaii PPO	$306.52

Bill Only AP 88184 Flow Cytometry 1st Marker

Facility

$746.00

Service Code	HCPCS 88184
Hospital Charge Code	8102065
Hospital Revenue Code	311
Min. Negotiated Rate	$634.10
Max. Negotiated Rate	$723.62
Rate for Payer: Cash Price	$484.90
Rate for Payer: Health Management Network Commercial	$634.10
Rate for Payer: Kaiser Permanente Commercial	$671.40
Rate for Payer: MDX Hawaii PPO	$723.62

Bill Only AP 88184 Flow Cytometry 1st Marker

Facility

$746.00

Service Code	HCPCS 88184
Hospital Charge Code	8102065
Hospital Revenue Code	311
Min. Negotiated Rate	$40.71
Max. Negotiated Rate	$723.62
Rate for Payer: AlohaCare Medicaid	$373.00
Rate for Payer: AlohaCare Medicare	$373.00
Rate for Payer: Cash Price	$484.90
Rate for Payer: Cash Price	$484.90
Rate for Payer: Devoted Health Medicare	$410.30
Rate for Payer: Hawaii Medical Service Association ABD	$40.71
Rate for Payer: Hawaii Medical Service Association Commercial	$457.76
Rate for Payer: Hawaii Medical Service Association Medicare	$373.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$44.43
Rate for Payer: Hawaii Western Management Group Commercial	$366.21
Rate for Payer: Health Management Network Commercial	$634.10
Rate for Payer: Humana Medicare	$373.00
Rate for Payer: Kaiser Permanente Commercial	$671.40
Rate for Payer: Kaiser Permanente Medicaid	$380.46
Rate for Payer: Kaiser Permanente Medicare	$373.00
Rate for Payer: MDX Hawaii PPO	$723.62
Rate for Payer: Ohana Health Plan Medicaid	$373.00
Rate for Payer: Ohana Health Plan Medicare	$373.00
Rate for Payer: UnitedHealthcare Medicaid	$40.71
Rate for Payer: UnitedHealthcare Medicare	$373.00
Rate for Payer: University Health Alliance Commercial	$152.44

Bill Only AP 88185 Flow Cytometry Ea Addl Marker

Facility

$230.00

Service Code	HCPCS 88185
Hospital Charge Code	8102066
Hospital Revenue Code	311
Min. Negotiated Rate	$19.96
Max. Negotiated Rate	$223.10
Rate for Payer: AlohaCare Medicaid	$115.00
Rate for Payer: AlohaCare Medicare	$115.00
Rate for Payer: Cash Price	$149.50
Rate for Payer: Cash Price	$149.50
Rate for Payer: Devoted Health Medicare	$126.50
Rate for Payer: Hawaii Medical Service Association ABD	$19.96
Rate for Payer: Hawaii Medical Service Association Medicare	$115.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.79
Rate for Payer: Hawaii Western Management Group Commercial	$218.50
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Humana Medicare	$115.00
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: Kaiser Permanente Medicaid	$117.30
Rate for Payer: Kaiser Permanente Medicare	$115.00
Rate for Payer: MDX Hawaii PPO	$223.10
Rate for Payer: Ohana Health Plan Medicaid	$115.00
Rate for Payer: Ohana Health Plan Medicare	$115.00
Rate for Payer: UnitedHealthcare Medicaid	$19.96
Rate for Payer: UnitedHealthcare Medicare	$115.00
Rate for Payer: University Health Alliance Commercial	$86.75

Bill Only AP 88185 Flow Cytometry Ea Addl Marker

Facility

$230.00

Service Code	HCPCS 88185
Hospital Charge Code	8102066
Hospital Revenue Code	311
Min. Negotiated Rate	$195.50
Max. Negotiated Rate	$223.10
Rate for Payer: Cash Price	$149.50
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: MDX Hawaii PPO	$223.10

Bill Only AP 88300 Surg Level I

Facility

$201.00

Service Code	HCPCS 88300 TC
Hospital Charge Code	8196778
Hospital Revenue Code	310
Min. Negotiated Rate	$170.85
Max. Negotiated Rate	$194.97
Rate for Payer: Cash Price	$130.65
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: MDX Hawaii PPO	$194.97

Bill Only AP 88300 Surg Level I

Facility

$201.00

Service Code	HCPCS 88300 TC
Hospital Charge Code	8196778
Hospital Revenue Code	310
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$194.97
Rate for Payer: AlohaCare Medicaid	$100.50
Rate for Payer: AlohaCare Medicare	$100.50
Rate for Payer: Cash Price	$130.65
Rate for Payer: Cash Price	$130.65
Rate for Payer: Devoted Health Medicare	$110.55
Rate for Payer: Hawaii Medical Service Association ABD	$13.56
Rate for Payer: Hawaii Medical Service Association Medicare	$100.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.32
Rate for Payer: Hawaii Western Management Group Commercial	$190.95
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Humana Medicare	$100.50
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: Kaiser Permanente Medicaid	$102.51
Rate for Payer: Kaiser Permanente Medicare	$100.50
Rate for Payer: MDX Hawaii PPO	$194.97
Rate for Payer: Ohana Health Plan Medicaid	$100.50
Rate for Payer: Ohana Health Plan Medicare	$100.50
Rate for Payer: UnitedHealthcare Medicaid	$13.56
Rate for Payer: UnitedHealthcare Medicare	$100.50
Rate for Payer: University Health Alliance Commercial	$38.96

Know your out-of-pocket cost for care.

All Charges