Kau Hospital

All Charges

Charge

Type

Setting

Price

HC RESUPERF WND FACE 5.1-7.5 CM

Facility

$791.00

Service Code	HCPCS 12014
Hospital Charge Code	4501201401
Hospital Revenue Code	450
Min. Negotiated Rate	$245.21
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$395.50
Rate for Payer: AlohaCare Medicare	$245.21
Rate for Payer: Cash Price	$474.60
Rate for Payer: Cash Price	$474.60
Rate for Payer: Devoted Health Medicare	$268.94
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$245.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$751.45
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Humana Medicare	$245.21
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$245.21
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: Ohana Health Plan Medicaid	$245.21
Rate for Payer: Ohana Health Plan Medicare	$245.21
Rate for Payer: UnitedHealthcare Medicare	$245.21
Rate for Payer: University Health Alliance Commercial	$576.56

HC RESUP NPTERF WND BODY 2.6-7.5 CM

Facility

$791.00

Service Code	HCPCS 12002
Hospital Charge Code	4501200201
Hospital Revenue Code	450
Min. Negotiated Rate	$245.21
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$395.50
Rate for Payer: AlohaCare Medicare	$245.21
Rate for Payer: Cash Price	$474.60
Rate for Payer: Cash Price	$474.60
Rate for Payer: Devoted Health Medicare	$268.94
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$245.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$751.45
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Humana Medicare	$245.21
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$245.21
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: Ohana Health Plan Medicaid	$245.21
Rate for Payer: Ohana Health Plan Medicare	$245.21
Rate for Payer: UnitedHealthcare Medicare	$245.21
Rate for Payer: University Health Alliance Commercial	$576.56

HC RESUP NPTERF WND BODY 2.6-7.5 CM

Facility

$791.00

Service Code	HCPCS 12002
Hospital Charge Code	4501200201
Hospital Revenue Code	450
Min. Negotiated Rate	$672.35
Max. Negotiated Rate	$767.27
Rate for Payer: Cash Price	$474.60
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: MDX Hawaii PPO	$767.27

HC RETICULOCYTE COUNT, AUTO - RETICULOCYTES

Facility

$33.00

Service Code	HCPCS 85045
Hospital Charge Code	3058504501
Hospital Revenue Code	305
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$19.80
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Kaiser Permanente Commercial	$29.70
Rate for Payer: MDX Hawaii PPO	$32.01

HC RETICULOCYTE COUNT, AUTO - RETICULOCYTES

Facility

$33.00

Service Code	HCPCS 85045
Hospital Charge Code	3058504501
Hospital Revenue Code	305
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$32.01
Rate for Payer: AlohaCare Medicaid	$16.50
Rate for Payer: AlohaCare Medicare	$10.23
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Devoted Health Medicare	$11.22
Rate for Payer: Hawaii Medical Service Association ABD	$5.59
Rate for Payer: Hawaii Medical Service Association Commercial	$4.99
Rate for Payer: Hawaii Medical Service Association Medicare	$10.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.87
Rate for Payer: Hawaii Western Management Group Commercial	$3.99
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Humana Medicare	$10.23
Rate for Payer: Kaiser Permanente Commercial	$29.70
Rate for Payer: Kaiser Permanente Medicaid	$16.83
Rate for Payer: Kaiser Permanente Medicare	$10.23
Rate for Payer: MDX Hawaii PPO	$32.01
Rate for Payer: Ohana Health Plan Medicaid	$10.23
Rate for Payer: Ohana Health Plan Medicare	$10.23
Rate for Payer: UnitedHealthcare Medicaid	$5.59
Rate for Payer: UnitedHealthcare Medicare	$10.23
Rate for Payer: University Health Alliance Commercial	$10.34

HC RHEUMATOID FACTOR, QUANT - RHEUMATOID FACTOR - RA QUANT

Facility

$48.00

Service Code	HCPCS 86431
Hospital Charge Code	3028643101
Hospital Revenue Code	302
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$46.56
Rate for Payer: AlohaCare Medicaid	$24.00
Rate for Payer: AlohaCare Medicare	$14.88
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Devoted Health Medicare	$16.32
Rate for Payer: Hawaii Medical Service Association ABD	$7.85
Rate for Payer: Hawaii Medical Service Association Commercial	$7.09
Rate for Payer: Hawaii Medical Service Association Medicare	$14.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.24
Rate for Payer: Hawaii Western Management Group Commercial	$5.67
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Humana Medicare	$14.88
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: Kaiser Permanente Medicare	$14.88
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: Ohana Health Plan Medicaid	$14.88
Rate for Payer: Ohana Health Plan Medicare	$14.88
Rate for Payer: UnitedHealthcare Medicaid	$7.85
Rate for Payer: UnitedHealthcare Medicare	$14.88
Rate for Payer: University Health Alliance Commercial	$14.67

HC RHEUMATOID FACTOR, QUANT - RHEUMATOID FACTOR - RA QUANT

Facility

$48.00

Service Code	HCPCS 86431
Hospital Charge Code	3028643101
Hospital Revenue Code	302
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: MDX Hawaii PPO	$46.56

HC ROOM DAILY

Facility

$1,500.00

Hospital Charge Code	1200000004
Hospital Revenue Code	120
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$7,250.00
Rate for Payer: AlohaCare Medicaid	$4,140.84
Rate for Payer: AlohaCare Medicare	$6,253.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Devoted Health Medicare	$7,175.30
Rate for Payer: Hawaii Medical Service Association ABD	$4,140.84
Rate for Payer: Hawaii Medical Service Association Medicare	$6,523.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,140.84
Rate for Payer: Hawaii Western Management Group Commercial	$7,250.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: Humana Medicare	$6,523.00
Rate for Payer: Kaiser Permanente Commercial	$1,350.00
Rate for Payer: Kaiser Permanente Medicaid	$4,140.84
Rate for Payer: Kaiser Permanente Medicare	$6,523.00
Rate for Payer: MDX Hawaii PPO	$1,455.00
Rate for Payer: Ohana Health Plan Medicaid	$4,140.84
Rate for Payer: Ohana Health Plan Medicare	$6,523.00
Rate for Payer: UnitedHealthcare Medicaid	$4,140.84
Rate for Payer: UnitedHealthcare Medicare	$6,523.00
Rate for Payer: University Health Alliance Commercial	$5,923.00

HC ROOM TREATMENT

Facility

$528.00

Service Code	HCPCS 99211
Hospital Charge Code	7619921102
Hospital Revenue Code	761
Min. Negotiated Rate	$448.80
Max. Negotiated Rate	$512.16
Rate for Payer: Cash Price	$316.80
Rate for Payer: Health Management Network Commercial	$448.80
Rate for Payer: Kaiser Permanente Commercial	$475.20
Rate for Payer: MDX Hawaii PPO	$512.16

HC ROOM TREATMENT

Facility

$528.00

Service Code	HCPCS 99211
Hospital Charge Code	7619921102
Hospital Revenue Code	761
Min. Negotiated Rate	$9.17
Max. Negotiated Rate	$512.16
Rate for Payer: AlohaCare Medicaid	$264.00
Rate for Payer: AlohaCare Medicare	$163.68
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Devoted Health Medicare	$179.52
Rate for Payer: Hawaii Medical Service Association Medicare	$163.68
Rate for Payer: Hawaii Western Management Group Commercial	$501.60
Rate for Payer: Health Management Network Commercial	$448.80
Rate for Payer: Humana Medicare	$163.68
Rate for Payer: Kaiser Permanente Commercial	$475.20
Rate for Payer: Kaiser Permanente Medicaid	$269.28
Rate for Payer: Kaiser Permanente Medicare	$163.68
Rate for Payer: MDX Hawaii PPO	$512.16
Rate for Payer: Ohana Health Plan Medicaid	$163.68
Rate for Payer: Ohana Health Plan Medicare	$163.68
Rate for Payer: UnitedHealthcare Medicaid	$9.17
Rate for Payer: UnitedHealthcare Medicare	$163.68
Rate for Payer: University Health Alliance Commercial	$384.86

HC RSV ID POCT

Facility

$589.00

Service Code	HCPCS 87634
Hospital Charge Code	3068763402
Hospital Revenue Code	306
Min. Negotiated Rate	$500.65
Max. Negotiated Rate	$571.33
Rate for Payer: Cash Price	$353.40
Rate for Payer: Health Management Network Commercial	$500.65
Rate for Payer: Kaiser Permanente Commercial	$530.10
Rate for Payer: MDX Hawaii PPO	$571.33

HC RSV ID POCT

Facility

$589.00

Service Code	HCPCS 87634
Hospital Charge Code	3068763402
Hospital Revenue Code	306
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$571.33
Rate for Payer: AlohaCare Medicaid	$294.50
Rate for Payer: AlohaCare Medicare	$182.59
Rate for Payer: Cash Price	$353.40
Rate for Payer: Cash Price	$353.40
Rate for Payer: Devoted Health Medicare	$200.26
Rate for Payer: Hawaii Medical Service Association ABD	$58.84
Rate for Payer: Hawaii Medical Service Association Commercial	$87.75
Rate for Payer: Hawaii Medical Service Association Medicare	$182.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$96.95
Rate for Payer: Hawaii Western Management Group Commercial	$70.20
Rate for Payer: Health Management Network Commercial	$500.65
Rate for Payer: Humana Medicare	$182.59
Rate for Payer: Kaiser Permanente Commercial	$530.10
Rate for Payer: Kaiser Permanente Medicaid	$300.39
Rate for Payer: Kaiser Permanente Medicare	$182.59
Rate for Payer: MDX Hawaii PPO	$571.33
Rate for Payer: Ohana Health Plan Medicaid	$182.59
Rate for Payer: Ohana Health Plan Medicare	$182.59
Rate for Payer: UnitedHealthcare Medicaid	$52.00
Rate for Payer: UnitedHealthcare Medicare	$182.59
Rate for Payer: University Health Alliance Commercial	$160.32

HC RT CONTINUOUS INHALATION TX, 1ST HR

Facility

$693.00

Service Code	HCPCS 94644
Hospital Charge Code	4109464401
Hospital Revenue Code	410
Min. Negotiated Rate	$589.05
Max. Negotiated Rate	$672.21
Rate for Payer: Cash Price	$415.80
Rate for Payer: Health Management Network Commercial	$589.05
Rate for Payer: Kaiser Permanente Commercial	$623.70
Rate for Payer: MDX Hawaii PPO	$672.21

HC RT CONTINUOUS INHALATION TX, 1ST HR

Facility

$693.00

Service Code	HCPCS 94644
Hospital Charge Code	4109464401
Hospital Revenue Code	410
Min. Negotiated Rate	$27.58
Max. Negotiated Rate	$672.21
Rate for Payer: AlohaCare Medicaid	$346.50
Rate for Payer: AlohaCare Medicare	$214.83
Rate for Payer: Cash Price	$415.80
Rate for Payer: Cash Price	$415.80
Rate for Payer: Devoted Health Medicare	$235.62
Rate for Payer: Hawaii Medical Service Association Commercial	$169.91
Rate for Payer: Hawaii Medical Service Association Medicare	$214.83
Rate for Payer: Hawaii Western Management Group Commercial	$658.35
Rate for Payer: Health Management Network Commercial	$589.05
Rate for Payer: Humana Medicare	$214.83
Rate for Payer: Kaiser Permanente Commercial	$623.70
Rate for Payer: Kaiser Permanente Medicaid	$353.43
Rate for Payer: Kaiser Permanente Medicare	$214.83
Rate for Payer: MDX Hawaii PPO	$672.21
Rate for Payer: Ohana Health Plan Medicaid	$214.83
Rate for Payer: Ohana Health Plan Medicare	$214.83
Rate for Payer: UnitedHealthcare Medicaid	$27.58
Rate for Payer: UnitedHealthcare Medicare	$214.83
Rate for Payer: University Health Alliance Commercial	$505.13

HC RT CONTINUOUS INHALATION TX, EACH ADD HR

Facility

$423.00

Service Code	HCPCS 94645
Hospital Charge Code	4109464501
Hospital Revenue Code	410
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$410.31
Rate for Payer: AlohaCare Medicaid	$211.50
Rate for Payer: AlohaCare Medicare	$131.13
Rate for Payer: Cash Price	$253.80
Rate for Payer: Cash Price	$253.80
Rate for Payer: Devoted Health Medicare	$143.82
Rate for Payer: Hawaii Medical Service Association Medicare	$131.13
Rate for Payer: Hawaii Western Management Group Commercial	$401.85
Rate for Payer: Health Management Network Commercial	$359.55
Rate for Payer: Humana Medicare	$131.13
Rate for Payer: Kaiser Permanente Commercial	$380.70
Rate for Payer: Kaiser Permanente Medicaid	$215.73
Rate for Payer: Kaiser Permanente Medicare	$131.13
Rate for Payer: MDX Hawaii PPO	$410.31
Rate for Payer: Ohana Health Plan Medicaid	$131.13
Rate for Payer: Ohana Health Plan Medicare	$131.13
Rate for Payer: UnitedHealthcare Medicaid	$10.46
Rate for Payer: UnitedHealthcare Medicare	$131.13
Rate for Payer: University Health Alliance Commercial	$308.32

HC RT CONTINUOUS INHALATION TX, EACH ADD HR

Facility

$423.00

Service Code	HCPCS 94645
Hospital Charge Code	4109464501
Hospital Revenue Code	410
Min. Negotiated Rate	$359.55
Max. Negotiated Rate	$410.31
Rate for Payer: Cash Price	$253.80
Rate for Payer: Health Management Network Commercial	$359.55
Rate for Payer: Kaiser Permanente Commercial	$380.70
Rate for Payer: MDX Hawaii PPO	$410.31

HC RT CPAP NON-EMERGENT

Facility

$1,092.00

Service Code	HCPCS 94660
Hospital Charge Code	4109466001
Hospital Revenue Code	410
Min. Negotiated Rate	$928.20
Max. Negotiated Rate	$1,059.24
Rate for Payer: Cash Price	$655.20
Rate for Payer: Health Management Network Commercial	$928.20
Rate for Payer: Kaiser Permanente Commercial	$982.80
Rate for Payer: MDX Hawaii PPO	$1,059.24

HC RT CPAP NON-EMERGENT

Facility

$1,092.00

Service Code	HCPCS 94660
Hospital Charge Code	4109466001
Hospital Revenue Code	410
Min. Negotiated Rate	$39.67
Max. Negotiated Rate	$1,059.24
Rate for Payer: AlohaCare Medicaid	$546.00
Rate for Payer: AlohaCare Medicare	$338.52
Rate for Payer: Cash Price	$655.20
Rate for Payer: Cash Price	$655.20
Rate for Payer: Devoted Health Medicare	$371.28
Rate for Payer: Hawaii Medical Service Association Commercial	$279.65
Rate for Payer: Hawaii Medical Service Association Medicare	$338.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,037.40
Rate for Payer: Health Management Network Commercial	$928.20
Rate for Payer: Humana Medicare	$338.52
Rate for Payer: Kaiser Permanente Commercial	$982.80
Rate for Payer: Kaiser Permanente Medicaid	$556.92
Rate for Payer: Kaiser Permanente Medicare	$338.52
Rate for Payer: MDX Hawaii PPO	$1,059.24
Rate for Payer: Ohana Health Plan Medicaid	$338.52
Rate for Payer: Ohana Health Plan Medicare	$338.52
Rate for Payer: UnitedHealthcare Medicaid	$39.67
Rate for Payer: UnitedHealthcare Medicare	$338.52
Rate for Payer: University Health Alliance Commercial	$795.96

HC RT DEMO &/OR EVAL,PT USE,AEROSOL DEVICE

Facility

$1,092.00

Service Code	HCPCS 94664
Hospital Charge Code	4109466401
Hospital Revenue Code	410
Min. Negotiated Rate	$14.35
Max. Negotiated Rate	$1,059.24
Rate for Payer: AlohaCare Medicaid	$546.00
Rate for Payer: AlohaCare Medicare	$338.52
Rate for Payer: Cash Price	$655.20
Rate for Payer: Cash Price	$655.20
Rate for Payer: Devoted Health Medicare	$371.28
Rate for Payer: Hawaii Medical Service Association Commercial	$279.65
Rate for Payer: Hawaii Medical Service Association Medicare	$338.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,037.40
Rate for Payer: Health Management Network Commercial	$928.20
Rate for Payer: Humana Medicare	$338.52
Rate for Payer: Kaiser Permanente Commercial	$982.80
Rate for Payer: Kaiser Permanente Medicaid	$556.92
Rate for Payer: Kaiser Permanente Medicare	$338.52
Rate for Payer: MDX Hawaii PPO	$1,059.24
Rate for Payer: Ohana Health Plan Medicaid	$338.52
Rate for Payer: Ohana Health Plan Medicare	$338.52
Rate for Payer: UnitedHealthcare Medicaid	$14.35
Rate for Payer: UnitedHealthcare Medicare	$338.52
Rate for Payer: University Health Alliance Commercial	$795.96

HC RT DEMO &/OR EVAL,PT USE,AEROSOL DEVICE

Facility

$1,092.00

Service Code	HCPCS 94664
Hospital Charge Code	4109466401
Hospital Revenue Code	410
Min. Negotiated Rate	$928.20
Max. Negotiated Rate	$1,059.24
Rate for Payer: Cash Price	$655.20
Rate for Payer: Health Management Network Commercial	$928.20
Rate for Payer: Kaiser Permanente Commercial	$982.80
Rate for Payer: MDX Hawaii PPO	$1,059.24

HC RT INHALATION TREATMENT

Facility

$1,092.00

Service Code	HCPCS 94640
Hospital Charge Code	4109464001
Hospital Revenue Code	410
Min. Negotiated Rate	$928.20
Max. Negotiated Rate	$1,059.24
Rate for Payer: Cash Price	$655.20
Rate for Payer: Health Management Network Commercial	$928.20
Rate for Payer: Kaiser Permanente Commercial	$982.80
Rate for Payer: MDX Hawaii PPO	$1,059.24

HC RT INHALATION TREATMENT

Facility

$1,092.00

Service Code	HCPCS 94640
Hospital Charge Code	4109464001
Hospital Revenue Code	410
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$1,059.24
Rate for Payer: AlohaCare Medicaid	$546.00
Rate for Payer: AlohaCare Medicare	$338.52
Rate for Payer: Cash Price	$655.20
Rate for Payer: Cash Price	$655.20
Rate for Payer: Devoted Health Medicare	$371.28
Rate for Payer: Hawaii Medical Service Association Commercial	$279.65
Rate for Payer: Hawaii Medical Service Association Medicare	$338.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,037.40
Rate for Payer: Health Management Network Commercial	$928.20
Rate for Payer: Humana Medicare	$338.52
Rate for Payer: Kaiser Permanente Commercial	$982.80
Rate for Payer: Kaiser Permanente Medicaid	$556.92
Rate for Payer: Kaiser Permanente Medicare	$338.52
Rate for Payer: MDX Hawaii PPO	$1,059.24
Rate for Payer: Ohana Health Plan Medicaid	$338.52
Rate for Payer: Ohana Health Plan Medicare	$338.52
Rate for Payer: UnitedHealthcare Medicaid	$13.32
Rate for Payer: UnitedHealthcare Medicare	$338.52
Rate for Payer: University Health Alliance Commercial	$795.96

HC RT NONINVASV OXYGEN SATUR;SINGLE

Facility

$79.00

Service Code	HCPCS 94760
Hospital Charge Code	4609476001
Hospital Revenue Code	460
Min. Negotiated Rate	$67.15
Max. Negotiated Rate	$76.63
Rate for Payer: Cash Price	$47.40
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Kaiser Permanente Commercial	$71.10
Rate for Payer: MDX Hawaii PPO	$76.63

HC RT NONINVASV OXYGEN SATUR;SINGLE

Facility

$79.00

Service Code	HCPCS 94760
Hospital Charge Code	4609476001
Hospital Revenue Code	460
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$76.63
Rate for Payer: AlohaCare Medicaid	$39.50
Rate for Payer: AlohaCare Medicare	$24.49
Rate for Payer: Cash Price	$47.40
Rate for Payer: Cash Price	$47.40
Rate for Payer: Devoted Health Medicare	$26.86
Rate for Payer: Hawaii Medical Service Association Medicare	$24.49
Rate for Payer: Hawaii Western Management Group Commercial	$75.05
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Humana Medicare	$24.49
Rate for Payer: Kaiser Permanente Commercial	$71.10
Rate for Payer: Kaiser Permanente Medicaid	$40.29
Rate for Payer: Kaiser Permanente Medicare	$24.49
Rate for Payer: MDX Hawaii PPO	$76.63
Rate for Payer: Ohana Health Plan Medicaid	$24.49
Rate for Payer: Ohana Health Plan Medicare	$24.49
Rate for Payer: UnitedHealthcare Medicaid	$2.29
Rate for Payer: UnitedHealthcare Medicare	$24.49
Rate for Payer: University Health Alliance Commercial	$57.58

HC RT NONINVASV OXYGEN SATUT,CONTINUOUS

Facility

$610.00

Service Code	HCPCS 94762
Hospital Charge Code	4109476201
Hospital Revenue Code	410
Min. Negotiated Rate	$518.50
Max. Negotiated Rate	$591.70
Rate for Payer: Cash Price	$366.00
Rate for Payer: Health Management Network Commercial	$518.50
Rate for Payer: Kaiser Permanente Commercial	$549.00
Rate for Payer: MDX Hawaii PPO	$591.70

Know your out-of-pocket cost for care.

All Charges