Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC CARDIAC STRESS TST,TRACING - DIPYRIDAMOLE W MYOCARDIAL PERF MULT

Facility

$1,549.00

Service Code	HCPCS 93017
Hospital Charge Code	4829301712
Hospital Revenue Code	482
Min. Negotiated Rate	$1,316.65
Max. Negotiated Rate	$1,502.53
Rate for Payer: Cash Price	$929.40
Rate for Payer: Health Management Network Commercial	$1,316.65
Rate for Payer: MDX Hawaii PPO	$1,502.53

HC CARDIAC STRESS TST,TRACING - DIPYRIDAMOLE W MYOCARDIAL PERF SING

Facility

$1,549.00

Service Code	HCPCS 93017
Hospital Charge Code	4829301711
Hospital Revenue Code	482
Min. Negotiated Rate	$1,316.65
Max. Negotiated Rate	$1,502.53
Rate for Payer: Cash Price	$929.40
Rate for Payer: Health Management Network Commercial	$1,316.65
Rate for Payer: MDX Hawaii PPO	$1,502.53

HC CARDIAC STRESS TST,TRACING - DIPYRIDAMOLE W MYOCARDIAL PERF SING

Facility

$1,549.00

Service Code	HCPCS 93017
Hospital Charge Code	4829301711
Hospital Revenue Code	482
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$1,502.53
Rate for Payer: AlohaCare Medicaid	$255.08
Rate for Payer: AlohaCare Medicare	$255.08
Rate for Payer: Cash Price	$929.40
Rate for Payer: Cash Price	$929.40
Rate for Payer: Devoted Health Medicare	$280.59
Rate for Payer: Hawaii Medical Service Association Commercial	$318.85
Rate for Payer: Hawaii Medical Service Association Medicare	$255.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,471.55
Rate for Payer: Health Management Network Commercial	$1,316.65
Rate for Payer: Humana Medicare	$255.08
Rate for Payer: Kaiser Permanente Commercial	$975.87
Rate for Payer: Kaiser Permanente Medicaid	$789.99
Rate for Payer: Kaiser Permanente Medicare	$255.08
Rate for Payer: MDX Hawaii PPO	$1,502.53
Rate for Payer: Ohana Health Plan Medicaid	$280.59
Rate for Payer: Ohana Health Plan Medicare	$255.08
Rate for Payer: UnitedHealthcare Medicaid	$55.90
Rate for Payer: UnitedHealthcare Medicare	$255.08
Rate for Payer: University Health Alliance Commercial	$1,129.07

HC CARDIAC STRESS TST,TRACING - DOBUTAMINE W MYOCARD PERFUSION MULT

Facility

$1,549.00

Service Code	HCPCS 93017
Hospital Charge Code	4829301706
Hospital Revenue Code	482
Min. Negotiated Rate	$1,316.65
Max. Negotiated Rate	$1,502.53
Rate for Payer: Cash Price	$929.40
Rate for Payer: Health Management Network Commercial	$1,316.65
Rate for Payer: MDX Hawaii PPO	$1,502.53

HC CARDIAC STRESS TST,TRACING - DOBUTAMINE W MYOCARD PERFUSION MULT

Facility

$1,549.00

Service Code	HCPCS 93017
Hospital Charge Code	4829301706
Hospital Revenue Code	482
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$1,502.53
Rate for Payer: AlohaCare Medicaid	$255.08
Rate for Payer: AlohaCare Medicare	$255.08
Rate for Payer: Cash Price	$929.40
Rate for Payer: Cash Price	$929.40
Rate for Payer: Devoted Health Medicare	$280.59
Rate for Payer: Hawaii Medical Service Association Commercial	$318.85
Rate for Payer: Hawaii Medical Service Association Medicare	$255.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,471.55
Rate for Payer: Health Management Network Commercial	$1,316.65
Rate for Payer: Humana Medicare	$255.08
Rate for Payer: Kaiser Permanente Commercial	$975.87
Rate for Payer: Kaiser Permanente Medicaid	$789.99
Rate for Payer: Kaiser Permanente Medicare	$255.08
Rate for Payer: MDX Hawaii PPO	$1,502.53
Rate for Payer: Ohana Health Plan Medicaid	$280.59
Rate for Payer: Ohana Health Plan Medicare	$255.08
Rate for Payer: UnitedHealthcare Medicaid	$55.90
Rate for Payer: UnitedHealthcare Medicare	$255.08
Rate for Payer: University Health Alliance Commercial	$1,129.07

HC CARDIAC STRESS TST,TRACING - DOBUTAMINE W MYOCARD PERFUSION SING

Facility

$1,549.00

Service Code	HCPCS 93017
Hospital Charge Code	4829301705
Hospital Revenue Code	482
Min. Negotiated Rate	$1,316.65
Max. Negotiated Rate	$1,502.53
Rate for Payer: Cash Price	$929.40
Rate for Payer: Health Management Network Commercial	$1,316.65
Rate for Payer: MDX Hawaii PPO	$1,502.53

HC CARDIAC STRESS TST,TRACING - DOBUTAMINE W MYOCARD PERFUSION SING

Facility

$1,549.00

Service Code	HCPCS 93017
Hospital Charge Code	4829301705
Hospital Revenue Code	482
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$1,502.53
Rate for Payer: AlohaCare Medicaid	$255.08
Rate for Payer: AlohaCare Medicare	$255.08
Rate for Payer: Cash Price	$929.40
Rate for Payer: Cash Price	$929.40
Rate for Payer: Devoted Health Medicare	$280.59
Rate for Payer: Hawaii Medical Service Association Commercial	$318.85
Rate for Payer: Hawaii Medical Service Association Medicare	$255.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,471.55
Rate for Payer: Health Management Network Commercial	$1,316.65
Rate for Payer: Humana Medicare	$255.08
Rate for Payer: Kaiser Permanente Commercial	$975.87
Rate for Payer: Kaiser Permanente Medicaid	$789.99
Rate for Payer: Kaiser Permanente Medicare	$255.08
Rate for Payer: MDX Hawaii PPO	$1,502.53
Rate for Payer: Ohana Health Plan Medicaid	$280.59
Rate for Payer: Ohana Health Plan Medicare	$255.08
Rate for Payer: UnitedHealthcare Medicaid	$55.90
Rate for Payer: UnitedHealthcare Medicare	$255.08
Rate for Payer: University Health Alliance Commercial	$1,129.07

HC CARDIAC STRESS TST,TRACING - EXERCISE W MYOCARDIAL PERF SPECT SING

Facility

$1,549.00

Service Code	HCPCS 93017
Hospital Charge Code	4829301728
Hospital Revenue Code	482
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$1,502.53
Rate for Payer: AlohaCare Medicaid	$255.08
Rate for Payer: AlohaCare Medicare	$255.08
Rate for Payer: Cash Price	$929.40
Rate for Payer: Cash Price	$929.40
Rate for Payer: Devoted Health Medicare	$280.59
Rate for Payer: Hawaii Medical Service Association Commercial	$318.85
Rate for Payer: Hawaii Medical Service Association Medicare	$255.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,471.55
Rate for Payer: Health Management Network Commercial	$1,316.65
Rate for Payer: Humana Medicare	$255.08
Rate for Payer: Kaiser Permanente Commercial	$975.87
Rate for Payer: Kaiser Permanente Medicaid	$789.99
Rate for Payer: Kaiser Permanente Medicare	$255.08
Rate for Payer: MDX Hawaii PPO	$1,502.53
Rate for Payer: Ohana Health Plan Medicaid	$280.59
Rate for Payer: Ohana Health Plan Medicare	$255.08
Rate for Payer: UnitedHealthcare Medicaid	$55.90
Rate for Payer: UnitedHealthcare Medicare	$255.08
Rate for Payer: University Health Alliance Commercial	$1,129.07

HC CARDIAC STRESS TST,TRACING - EXERCISE W MYOCARDIAL PERF SPECT SING

Facility

$1,549.00

Service Code	HCPCS 93017
Hospital Charge Code	4829301728
Hospital Revenue Code	482
Min. Negotiated Rate	$1,316.65
Max. Negotiated Rate	$1,502.53
Rate for Payer: Cash Price	$929.40
Rate for Payer: Health Management Network Commercial	$1,316.65
Rate for Payer: MDX Hawaii PPO	$1,502.53

HC CARDIAC STRESS TST,TRACING - EXERCISE W MYOCARDIAL PERFUSION MULT

Facility

$1,549.00

Service Code	HCPCS 93017
Hospital Charge Code	4829301732
Hospital Revenue Code	482
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$1,502.53
Rate for Payer: AlohaCare Medicaid	$255.08
Rate for Payer: AlohaCare Medicare	$255.08
Rate for Payer: Cash Price	$929.40
Rate for Payer: Cash Price	$929.40
Rate for Payer: Devoted Health Medicare	$280.59
Rate for Payer: Hawaii Medical Service Association Commercial	$318.85
Rate for Payer: Hawaii Medical Service Association Medicare	$255.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,471.55
Rate for Payer: Health Management Network Commercial	$1,316.65
Rate for Payer: Humana Medicare	$255.08
Rate for Payer: Kaiser Permanente Commercial	$975.87
Rate for Payer: Kaiser Permanente Medicaid	$789.99
Rate for Payer: Kaiser Permanente Medicare	$255.08
Rate for Payer: MDX Hawaii PPO	$1,502.53
Rate for Payer: Ohana Health Plan Medicaid	$280.59
Rate for Payer: Ohana Health Plan Medicare	$255.08
Rate for Payer: UnitedHealthcare Medicaid	$55.90
Rate for Payer: UnitedHealthcare Medicare	$255.08
Rate for Payer: University Health Alliance Commercial	$1,129.07

HC CARDIAC STRESS TST,TRACING - EXERCISE W MYOCARDIAL PERFUSION MULT

Facility

$1,549.00

Service Code	HCPCS 93017
Hospital Charge Code	4829301732
Hospital Revenue Code	482
Min. Negotiated Rate	$1,316.65
Max. Negotiated Rate	$1,502.53
Rate for Payer: Cash Price	$929.40
Rate for Payer: Health Management Network Commercial	$1,316.65
Rate for Payer: MDX Hawaii PPO	$1,502.53

HC CARDIAC STRESS TST,TRACING ONLY

Facility

$1,549.00

Service Code	HCPCS 93017
Hospital Charge Code	4829301701
Hospital Revenue Code	482
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$1,502.53
Rate for Payer: AlohaCare Medicaid	$255.08
Rate for Payer: AlohaCare Medicare	$255.08
Rate for Payer: Cash Price	$929.40
Rate for Payer: Cash Price	$929.40
Rate for Payer: Devoted Health Medicare	$280.59
Rate for Payer: Hawaii Medical Service Association Commercial	$318.85
Rate for Payer: Hawaii Medical Service Association Medicare	$255.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,471.55
Rate for Payer: Health Management Network Commercial	$1,316.65
Rate for Payer: Humana Medicare	$255.08
Rate for Payer: Kaiser Permanente Commercial	$975.87
Rate for Payer: Kaiser Permanente Medicaid	$789.99
Rate for Payer: Kaiser Permanente Medicare	$255.08
Rate for Payer: MDX Hawaii PPO	$1,502.53
Rate for Payer: Ohana Health Plan Medicaid	$280.59
Rate for Payer: Ohana Health Plan Medicare	$255.08
Rate for Payer: UnitedHealthcare Medicaid	$55.90
Rate for Payer: UnitedHealthcare Medicare	$255.08
Rate for Payer: University Health Alliance Commercial	$1,129.07

HC CARDIAC STRESS TST,TRACING ONLY

Facility

$1,549.00

Service Code	HCPCS 93017
Hospital Charge Code	4829301701
Hospital Revenue Code	482
Min. Negotiated Rate	$1,316.65
Max. Negotiated Rate	$1,502.53
Rate for Payer: Cash Price	$929.40
Rate for Payer: Health Management Network Commercial	$1,316.65
Rate for Payer: MDX Hawaii PPO	$1,502.53

HC CARDIAC STRESS TST,TRACING - REGADENOSON W MYOCARDIAL PERFUSION MULT

Facility

$1,549.00

Service Code	HCPCS 93017
Hospital Charge Code	4829301718
Hospital Revenue Code	482
Min. Negotiated Rate	$1,316.65
Max. Negotiated Rate	$1,502.53
Rate for Payer: Cash Price	$929.40
Rate for Payer: Health Management Network Commercial	$1,316.65
Rate for Payer: MDX Hawaii PPO	$1,502.53

HC CARDIAC STRESS TST,TRACING - REGADENOSON W MYOCARDIAL PERFUSION MULT

Facility

$1,549.00

Service Code	HCPCS 93017
Hospital Charge Code	4829301718
Hospital Revenue Code	482
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$1,502.53
Rate for Payer: AlohaCare Medicaid	$255.08
Rate for Payer: AlohaCare Medicare	$255.08
Rate for Payer: Cash Price	$929.40
Rate for Payer: Cash Price	$929.40
Rate for Payer: Devoted Health Medicare	$280.59
Rate for Payer: Hawaii Medical Service Association Commercial	$318.85
Rate for Payer: Hawaii Medical Service Association Medicare	$255.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,471.55
Rate for Payer: Health Management Network Commercial	$1,316.65
Rate for Payer: Humana Medicare	$255.08
Rate for Payer: Kaiser Permanente Commercial	$975.87
Rate for Payer: Kaiser Permanente Medicaid	$789.99
Rate for Payer: Kaiser Permanente Medicare	$255.08
Rate for Payer: MDX Hawaii PPO	$1,502.53
Rate for Payer: Ohana Health Plan Medicaid	$280.59
Rate for Payer: Ohana Health Plan Medicare	$255.08
Rate for Payer: UnitedHealthcare Medicaid	$55.90
Rate for Payer: UnitedHealthcare Medicare	$255.08
Rate for Payer: University Health Alliance Commercial	$1,129.07

HC CARDIAC STRESS TST,TRACING - REGADENOSON W MYOCARDIAL PERFUSION SING

Facility

$1,549.00

Service Code	HCPCS 93017
Hospital Charge Code	4829301717
Hospital Revenue Code	482
Min. Negotiated Rate	$1,316.65
Max. Negotiated Rate	$1,502.53
Rate for Payer: Cash Price	$929.40
Rate for Payer: Health Management Network Commercial	$1,316.65
Rate for Payer: MDX Hawaii PPO	$1,502.53

HC CARDIAC STRESS TST,TRACING - REGADENOSON W MYOCARDIAL PERFUSION SING

Facility

$1,549.00

Service Code	HCPCS 93017
Hospital Charge Code	4829301717
Hospital Revenue Code	482
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$1,502.53
Rate for Payer: AlohaCare Medicaid	$255.08
Rate for Payer: AlohaCare Medicare	$255.08
Rate for Payer: Cash Price	$929.40
Rate for Payer: Cash Price	$929.40
Rate for Payer: Devoted Health Medicare	$280.59
Rate for Payer: Hawaii Medical Service Association Commercial	$318.85
Rate for Payer: Hawaii Medical Service Association Medicare	$255.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,471.55
Rate for Payer: Health Management Network Commercial	$1,316.65
Rate for Payer: Humana Medicare	$255.08
Rate for Payer: Kaiser Permanente Commercial	$975.87
Rate for Payer: Kaiser Permanente Medicaid	$789.99
Rate for Payer: Kaiser Permanente Medicare	$255.08
Rate for Payer: MDX Hawaii PPO	$1,502.53
Rate for Payer: Ohana Health Plan Medicaid	$280.59
Rate for Payer: Ohana Health Plan Medicare	$255.08
Rate for Payer: UnitedHealthcare Medicaid	$55.90
Rate for Payer: UnitedHealthcare Medicare	$255.08
Rate for Payer: University Health Alliance Commercial	$1,129.07

HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY, IGA

Facility

$214.00

Service Code	HCPCS 86147
Hospital Charge Code	3028614702
Hospital Revenue Code	302
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$207.58
Rate for Payer: AlohaCare Medicaid	$25.45
Rate for Payer: AlohaCare Medicare	$25.45
Rate for Payer: Cash Price	$128.40
Rate for Payer: Cash Price	$128.40
Rate for Payer: Devoted Health Medicare	$28.00
Rate for Payer: Hawaii Medical Service Association ABD	$35.16
Rate for Payer: Hawaii Medical Service Association Commercial	$31.81
Rate for Payer: Hawaii Medical Service Association Medicare	$25.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.92
Rate for Payer: Hawaii Western Management Group Commercial	$25.45
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Humana Medicare	$25.45
Rate for Payer: Kaiser Permanente Commercial	$134.82
Rate for Payer: Kaiser Permanente Medicaid	$109.14
Rate for Payer: Kaiser Permanente Medicare	$25.45
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: Ohana Health Plan Medicaid	$28.00
Rate for Payer: Ohana Health Plan Medicare	$25.45
Rate for Payer: UnitedHealthcare Medicaid	$35.16
Rate for Payer: UnitedHealthcare Medicare	$25.45
Rate for Payer: University Health Alliance Commercial	$65.75

HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY, IGA

Facility

$214.00

Service Code	HCPCS 86147
Hospital Charge Code	3028614702
Hospital Revenue Code	302
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: MDX Hawaii PPO	$207.58

HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY, IGG

Facility

$214.00

Service Code	HCPCS 86147
Hospital Charge Code	3028614703
Hospital Revenue Code	302
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$207.58
Rate for Payer: AlohaCare Medicaid	$25.45
Rate for Payer: AlohaCare Medicare	$25.45
Rate for Payer: Cash Price	$128.40
Rate for Payer: Cash Price	$128.40
Rate for Payer: Devoted Health Medicare	$28.00
Rate for Payer: Hawaii Medical Service Association ABD	$35.16
Rate for Payer: Hawaii Medical Service Association Commercial	$31.81
Rate for Payer: Hawaii Medical Service Association Medicare	$25.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.92
Rate for Payer: Hawaii Western Management Group Commercial	$25.45
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Humana Medicare	$25.45
Rate for Payer: Kaiser Permanente Commercial	$134.82
Rate for Payer: Kaiser Permanente Medicaid	$109.14
Rate for Payer: Kaiser Permanente Medicare	$25.45
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: Ohana Health Plan Medicaid	$28.00
Rate for Payer: Ohana Health Plan Medicare	$25.45
Rate for Payer: UnitedHealthcare Medicaid	$35.16
Rate for Payer: UnitedHealthcare Medicare	$25.45
Rate for Payer: University Health Alliance Commercial	$65.75

HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY, IGG

Facility

$214.00

Service Code	HCPCS 86147
Hospital Charge Code	3028614703
Hospital Revenue Code	302
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: MDX Hawaii PPO	$207.58

HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY, IGM

Facility

$214.00

Service Code	HCPCS 86147
Hospital Charge Code	3028614704
Hospital Revenue Code	302
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$207.58
Rate for Payer: AlohaCare Medicaid	$25.45
Rate for Payer: AlohaCare Medicare	$25.45
Rate for Payer: Cash Price	$128.40
Rate for Payer: Cash Price	$128.40
Rate for Payer: Devoted Health Medicare	$28.00
Rate for Payer: Hawaii Medical Service Association ABD	$35.16
Rate for Payer: Hawaii Medical Service Association Commercial	$31.81
Rate for Payer: Hawaii Medical Service Association Medicare	$25.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.92
Rate for Payer: Hawaii Western Management Group Commercial	$25.45
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Humana Medicare	$25.45
Rate for Payer: Kaiser Permanente Commercial	$134.82
Rate for Payer: Kaiser Permanente Medicaid	$109.14
Rate for Payer: Kaiser Permanente Medicare	$25.45
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: Ohana Health Plan Medicaid	$28.00
Rate for Payer: Ohana Health Plan Medicare	$25.45
Rate for Payer: UnitedHealthcare Medicaid	$35.16
Rate for Payer: UnitedHealthcare Medicare	$25.45
Rate for Payer: University Health Alliance Commercial	$65.75

HC CARDIOLIPIN ANTIBODY - CARDIOLIPIN ANTIBODY, IGM

Facility

$214.00

Service Code	HCPCS 86147
Hospital Charge Code	3028614704
Hospital Revenue Code	302
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: MDX Hawaii PPO	$207.58

HC CARDIOVERSION ELECTRIC EXT - CARDIOVERSION EXTERNAL

Facility

$3,255.00

Service Code	HCPCS 92960
Hospital Charge Code	4809296001
Hospital Revenue Code	480
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$780.80
Rate for Payer: AlohaCare Medicare	$780.80
Rate for Payer: Cash Price	$1,953.00
Rate for Payer: Cash Price	$1,953.00
Rate for Payer: Cash Price	$1,953.00
Rate for Payer: Devoted Health Medicare	$858.88
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$780.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Hawaii Western Management Group Commercial	$3,092.25
Rate for Payer: Health Management Network Commercial	$2,766.75
Rate for Payer: Humana Medicare	$780.80
Rate for Payer: Kaiser Permanente Commercial	$2,050.65
Rate for Payer: Kaiser Permanente Medicaid	$1,660.05
Rate for Payer: Kaiser Permanente Medicare	$780.80
Rate for Payer: MDX Hawaii PPO	$3,157.35
Rate for Payer: Ohana Health Plan Medicaid	$858.88
Rate for Payer: Ohana Health Plan Medicare	$780.80
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$780.80
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC CARDIOVERSION ELECTRIC EXT - CARDIOVERSION EXTERNAL

Facility

$3,255.00

Service Code	HCPCS 92960
Hospital Charge Code	4809296001
Hospital Revenue Code	480
Min. Negotiated Rate	$2,766.75
Max. Negotiated Rate	$3,157.35
Rate for Payer: Cash Price	$1,953.00
Rate for Payer: Health Management Network Commercial	$2,766.75
Rate for Payer: MDX Hawaii PPO	$3,157.35

Know your out-of-pocket cost for care.

All Charges