Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

67700-Drain Abscess Blepharotomy/Eyelid

Facility

$1,780.00

Service Code	HCPCS 67700
Hospital Charge Code	8080066
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$1,726.60
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$890.00
Rate for Payer: Cash Price	$1,157.00
Rate for Payer: Cash Price	$1,157.00
Rate for Payer: Cash Price	$1,157.00
Rate for Payer: Devoted Health Medicare	$979.00
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$890.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,691.00
Rate for Payer: Health Management Network Commercial	$1,513.00
Rate for Payer: Humana Medicare	$890.00
Rate for Payer: Kaiser Permanente Commercial	$1,602.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$890.00
Rate for Payer: MDX Hawaii PPO	$1,726.60
Rate for Payer: Ohana Health Plan Medicaid	$890.00
Rate for Payer: Ohana Health Plan Medicare	$890.00
Rate for Payer: UnitedHealthcare Medicare	$890.00
Rate for Payer: University Health Alliance Commercial	$1,297.44

67700-Drain Abscess Blepharotomy/Eyelid

Facility

$1,780.00

Service Code	HCPCS 67700
Hospital Charge Code	8080066
Hospital Revenue Code	450
Min. Negotiated Rate	$1,513.00
Max. Negotiated Rate	$1,726.60
Rate for Payer: Cash Price	$1,157.00
Rate for Payer: Health Management Network Commercial	$1,513.00
Rate for Payer: Kaiser Permanente Commercial	$1,602.00
Rate for Payer: MDX Hawaii PPO	$1,726.60

67715 Canthotomy (separate procedure)

Professional

Both

$3,309.00

Service Code	HCPCS 67715
Hospital Charge Code	8040409
Hospital Revenue Code	975
Min. Negotiated Rate	$80.34
Max. Negotiated Rate	$2,812.65
Rate for Payer: AlohaCare Medicaid	$113.34
Rate for Payer: AlohaCare Medicare	$107.18
Rate for Payer: Cash Price	$2,150.85
Rate for Payer: Cash Price	$2,150.85
Rate for Payer: Devoted Health Medicare	$117.90
Rate for Payer: Hawaii Medical Service Association ABD	$113.34
Rate for Payer: Hawaii Medical Service Association Commercial	$186.41
Rate for Payer: Hawaii Medical Service Association Medicare	$107.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$113.34
Rate for Payer: Hawaii Western Management Group Commercial	$80.34
Rate for Payer: Health Management Network Commercial	$2,812.65
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: Kaiser Permanente Medicaid	$117.90
Rate for Payer: Kaiser Permanente Medicare	$117.90
Rate for Payer: Ohana Health Plan Medicaid	$113.34
Rate for Payer: Ohana Health Plan Medicare	$107.18
Rate for Payer: UnitedHealthcare Medicaid	$113.34
Rate for Payer: UnitedHealthcare Medicare	$107.18
Rate for Payer: University Health Alliance Commercial	$146.81

67715 CANTHOTOMY SEPARATE PROCEDURE CHARGE

Facility

$5,158.00

Service Code	HCPCS 67715
Hospital Charge Code	8669271
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$5,003.26
Rate for Payer: AlohaCare Medicaid	$672.48
Rate for Payer: AlohaCare Medicare	$2,579.00
Rate for Payer: Cash Price	$3,352.70
Rate for Payer: Cash Price	$3,352.70
Rate for Payer: Devoted Health Medicare	$2,836.90
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,579.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$4,900.10
Rate for Payer: Health Management Network Commercial	$4,384.30
Rate for Payer: Humana Medicare	$2,579.00
Rate for Payer: Kaiser Permanente Commercial	$4,642.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,579.00
Rate for Payer: MDX Hawaii PPO	$5,003.26
Rate for Payer: Ohana Health Plan Medicaid	$2,579.00
Rate for Payer: Ohana Health Plan Medicare	$2,579.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,579.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

67715 CANTHOTOMY SEPARATE PROCEDURE CHARGE

Facility

$5,158.00

Service Code	HCPCS 67715
Hospital Charge Code	8669271
Hospital Revenue Code	450
Min. Negotiated Rate	$4,384.30
Max. Negotiated Rate	$5,003.26
Rate for Payer: Cash Price	$3,352.70
Rate for Payer: Health Management Network Commercial	$4,384.30
Rate for Payer: Kaiser Permanente Commercial	$4,642.20
Rate for Payer: MDX Hawaii PPO	$5,003.26

67938-Eyelid Embedded Foreign Body

Facility

$760.00

Service Code	HCPCS 67938
Hospital Charge Code	8080144
Hospital Revenue Code	450
Min. Negotiated Rate	$646.00
Max. Negotiated Rate	$737.20
Rate for Payer: Cash Price	$494.00
Rate for Payer: Health Management Network Commercial	$646.00
Rate for Payer: Kaiser Permanente Commercial	$684.00
Rate for Payer: MDX Hawaii PPO	$737.20

67938-Eyelid Embedded Foreign Body

Facility

$760.00

Service Code	HCPCS 67938
Hospital Charge Code	8080144
Hospital Revenue Code	450
Min. Negotiated Rate	$380.00
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$380.00
Rate for Payer: Cash Price	$494.00
Rate for Payer: Cash Price	$494.00
Rate for Payer: Cash Price	$494.00
Rate for Payer: Devoted Health Medicare	$418.00
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Medicare	$380.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$722.00
Rate for Payer: Health Management Network Commercial	$646.00
Rate for Payer: Humana Medicare	$380.00
Rate for Payer: Kaiser Permanente Commercial	$684.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$380.00
Rate for Payer: MDX Hawaii PPO	$737.20
Rate for Payer: Ohana Health Plan Medicaid	$380.00
Rate for Payer: Ohana Health Plan Medicare	$380.00
Rate for Payer: UnitedHealthcare Medicare	$380.00
Rate for Payer: University Health Alliance Commercial	$553.96

67938 REMOVAL EMBEDDED FOREIGN BODY EYELID TechFee

Facility

$781.00

Service Code	HCPCS 67938
Hospital Charge Code	8211353
Hospital Revenue Code	450
Min. Negotiated Rate	$390.50
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$390.50
Rate for Payer: Cash Price	$507.65
Rate for Payer: Cash Price	$507.65
Rate for Payer: Cash Price	$507.65
Rate for Payer: Devoted Health Medicare	$429.55
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Medicare	$390.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$741.95
Rate for Payer: Health Management Network Commercial	$663.85
Rate for Payer: Humana Medicare	$390.50
Rate for Payer: Kaiser Permanente Commercial	$702.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$390.50
Rate for Payer: MDX Hawaii PPO	$757.57
Rate for Payer: Ohana Health Plan Medicaid	$390.50
Rate for Payer: Ohana Health Plan Medicare	$390.50
Rate for Payer: UnitedHealthcare Medicare	$390.50
Rate for Payer: University Health Alliance Commercial	$569.27

67938 REMOVAL EMBEDDED FOREIGN BODY EYELID TechFee

Facility

$781.00

Service Code	HCPCS 67938
Hospital Charge Code	8211353
Hospital Revenue Code	450
Min. Negotiated Rate	$663.85
Max. Negotiated Rate	$757.57
Rate for Payer: Cash Price	$507.65
Rate for Payer: Health Management Network Commercial	$663.85
Rate for Payer: Kaiser Permanente Commercial	$702.90
Rate for Payer: MDX Hawaii PPO	$757.57

69000-Drainage External Ear Abscess/Hematoma

Facility

$1,416.00

Service Code	HCPCS 69000
Hospital Charge Code	8080068
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$708.00
Rate for Payer: Cash Price	$920.40
Rate for Payer: Cash Price	$920.40
Rate for Payer: Cash Price	$920.40
Rate for Payer: Devoted Health Medicare	$778.80
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$708.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,345.20
Rate for Payer: Health Management Network Commercial	$1,203.60
Rate for Payer: Humana Medicare	$708.00
Rate for Payer: Kaiser Permanente Commercial	$1,274.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$708.00
Rate for Payer: MDX Hawaii PPO	$1,373.52
Rate for Payer: Ohana Health Plan Medicaid	$708.00
Rate for Payer: Ohana Health Plan Medicare	$708.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$708.00
Rate for Payer: University Health Alliance Commercial	$1,032.12

69000-Drainage External Ear Abscess/Hematoma

Facility

$1,416.00

Service Code	HCPCS 69000
Hospital Charge Code	8080068
Hospital Revenue Code	450
Min. Negotiated Rate	$1,203.60
Max. Negotiated Rate	$1,373.52
Rate for Payer: Cash Price	$920.40
Rate for Payer: Health Management Network Commercial	$1,203.60
Rate for Payer: Kaiser Permanente Commercial	$1,274.40
Rate for Payer: MDX Hawaii PPO	$1,373.52

69000 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPL

Facility

$1,620.00

Service Code	HCPCS 69000
Hospital Charge Code	8211354
Hospital Revenue Code	450
Min. Negotiated Rate	$1,377.00
Max. Negotiated Rate	$1,571.40
Rate for Payer: Cash Price	$1,053.00
Rate for Payer: Health Management Network Commercial	$1,377.00
Rate for Payer: Kaiser Permanente Commercial	$1,458.00
Rate for Payer: MDX Hawaii PPO	$1,571.40

69000 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPL

Facility

$1,620.00

Service Code	HCPCS 69000
Hospital Charge Code	8211354
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$810.00
Rate for Payer: Cash Price	$1,053.00
Rate for Payer: Cash Price	$1,053.00
Rate for Payer: Cash Price	$1,053.00
Rate for Payer: Devoted Health Medicare	$891.00
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$810.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,539.00
Rate for Payer: Health Management Network Commercial	$1,377.00
Rate for Payer: Humana Medicare	$810.00
Rate for Payer: Kaiser Permanente Commercial	$1,458.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$810.00
Rate for Payer: MDX Hawaii PPO	$1,571.40
Rate for Payer: Ohana Health Plan Medicaid	$810.00
Rate for Payer: Ohana Health Plan Medicare	$810.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$810.00
Rate for Payer: University Health Alliance Commercial	$1,180.82

69005 Drainage external ear, abscess or hematoma; complicated

Facility

$5,205.00

Service Code	HCPCS 69005
Hospital Charge Code	8040479
Hospital Revenue Code	361
Min. Negotiated Rate	$4,424.25
Max. Negotiated Rate	$5,048.85
Rate for Payer: Cash Price	$3,383.25
Rate for Payer: Health Management Network Commercial	$4,424.25
Rate for Payer: Kaiser Permanente Commercial	$4,684.50
Rate for Payer: MDX Hawaii PPO	$5,048.85

69005 Drainage external ear, abscess or hematoma; complicated

Facility

$5,205.00

Service Code	HCPCS 69005
Hospital Charge Code	8040479
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,048.85
Rate for Payer: AlohaCare Medicaid	$2,602.50
Rate for Payer: AlohaCare Medicare	$2,602.50
Rate for Payer: Cash Price	$3,383.25
Rate for Payer: Cash Price	$3,383.25
Rate for Payer: Cash Price	$3,383.25
Rate for Payer: Devoted Health Medicare	$2,862.75
Rate for Payer: Hawaii Medical Service Association Commercial	$2,109.21
Rate for Payer: Hawaii Medical Service Association Medicare	$2,602.50
Rate for Payer: Health Management Network Commercial	$4,424.25
Rate for Payer: Humana Medicare	$2,602.50
Rate for Payer: Kaiser Permanente Commercial	$4,684.50
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,602.50
Rate for Payer: MDX Hawaii PPO	$5,048.85
Rate for Payer: Ohana Health Plan Medicaid	$2,602.50
Rate for Payer: Ohana Health Plan Medicare	$2,602.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,602.50
Rate for Payer: University Health Alliance Commercial	$4,035.20

69005 Drainage external ear, abscess or hematoma; complicated

Professional

Both

$2,299.00

Service Code	HCPCS 69005
Hospital Charge Code	8040479
Hospital Revenue Code	975
Min. Negotiated Rate	$132.86
Max. Negotiated Rate	$1,954.15
Rate for Payer: AlohaCare Medicaid	$169.86
Rate for Payer: AlohaCare Medicare	$150.53
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Devoted Health Medicare	$165.58
Rate for Payer: Hawaii Medical Service Association ABD	$169.86
Rate for Payer: Hawaii Medical Service Association Commercial	$277.95
Rate for Payer: Hawaii Medical Service Association Medicare	$150.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$169.86
Rate for Payer: Hawaii Western Management Group Commercial	$132.86
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Kaiser Permanente Commercial	$165.58
Rate for Payer: Kaiser Permanente Medicaid	$165.58
Rate for Payer: Kaiser Permanente Medicare	$165.58
Rate for Payer: Ohana Health Plan Medicaid	$169.86
Rate for Payer: Ohana Health Plan Medicare	$150.53
Rate for Payer: UnitedHealthcare Medicaid	$169.86
Rate for Payer: UnitedHealthcare Medicare	$150.53
Rate for Payer: University Health Alliance Commercial	$218.91

69020-Drainage External Auditory Canal Abscess

Facility

$3,625.00

Service Code	HCPCS 69020
Hospital Charge Code	8080070
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,516.25
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$1,812.50
Rate for Payer: Cash Price	$2,356.25
Rate for Payer: Cash Price	$2,356.25
Rate for Payer: Cash Price	$2,356.25
Rate for Payer: Devoted Health Medicare	$1,993.75
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,812.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,443.75
Rate for Payer: Health Management Network Commercial	$3,081.25
Rate for Payer: Humana Medicare	$1,812.50
Rate for Payer: Kaiser Permanente Commercial	$3,262.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,812.50
Rate for Payer: MDX Hawaii PPO	$3,516.25
Rate for Payer: Ohana Health Plan Medicaid	$1,812.50
Rate for Payer: Ohana Health Plan Medicare	$1,812.50
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,812.50
Rate for Payer: University Health Alliance Commercial	$2,642.26

69020-Drainage External Auditory Canal Abscess

Facility

$3,625.00

Service Code	HCPCS 69020
Hospital Charge Code	8080070
Hospital Revenue Code	450
Min. Negotiated Rate	$3,081.25
Max. Negotiated Rate	$3,516.25
Rate for Payer: Cash Price	$2,356.25
Rate for Payer: Health Management Network Commercial	$3,081.25
Rate for Payer: Kaiser Permanente Commercial	$3,262.50
Rate for Payer: MDX Hawaii PPO	$3,516.25

69200-External Auditory Canal

Facility

$369.00

Service Code	HCPCS 69200
Hospital Charge Code	8080146
Hospital Revenue Code	450
Min. Negotiated Rate	$313.65
Max. Negotiated Rate	$357.93
Rate for Payer: Cash Price	$239.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: MDX Hawaii PPO	$357.93

69200-External Auditory Canal

Facility

$369.00

Service Code	HCPCS 69200
Hospital Charge Code	8080146
Hospital Revenue Code	450
Min. Negotiated Rate	$184.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$184.50
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$239.85
Rate for Payer: Devoted Health Medicare	$202.95
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$184.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$350.55
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Humana Medicare	$184.50
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$184.50
Rate for Payer: MDX Hawaii PPO	$357.93
Rate for Payer: Ohana Health Plan Medicaid	$184.50
Rate for Payer: Ohana Health Plan Medicare	$184.50
Rate for Payer: UnitedHealthcare Medicare	$184.50
Rate for Payer: University Health Alliance Commercial	$268.96

69200 RMVL FB XTRNL AUDITORY CANAL W/O ANES TechFee

Facility

$464.00

Service Code	HCPCS 69200
Hospital Charge Code	8211355
Hospital Revenue Code	450
Min. Negotiated Rate	$394.40
Max. Negotiated Rate	$450.08
Rate for Payer: Cash Price	$301.60
Rate for Payer: Health Management Network Commercial	$394.40
Rate for Payer: Kaiser Permanente Commercial	$417.60
Rate for Payer: MDX Hawaii PPO	$450.08

69200 RMVL FB XTRNL AUDITORY CANAL W/O ANES TechFee

Facility

$464.00

Service Code	HCPCS 69200
Hospital Charge Code	8211355
Hospital Revenue Code	450
Min. Negotiated Rate	$232.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$232.00
Rate for Payer: Cash Price	$301.60
Rate for Payer: Cash Price	$301.60
Rate for Payer: Cash Price	$301.60
Rate for Payer: Devoted Health Medicare	$255.20
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$232.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$440.80
Rate for Payer: Health Management Network Commercial	$394.40
Rate for Payer: Humana Medicare	$232.00
Rate for Payer: Kaiser Permanente Commercial	$417.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$232.00
Rate for Payer: MDX Hawaii PPO	$450.08
Rate for Payer: Ohana Health Plan Medicaid	$232.00
Rate for Payer: Ohana Health Plan Medicare	$232.00
Rate for Payer: UnitedHealthcare Medicare	$232.00
Rate for Payer: University Health Alliance Commercial	$338.21

69209-Cerumen Irrigation/Lavage

Facility

$404.00

Service Code	HCPCS 69209
Hospital Charge Code	8080148
Hospital Revenue Code	450
Min. Negotiated Rate	$343.40
Max. Negotiated Rate	$391.88
Rate for Payer: Cash Price	$262.60
Rate for Payer: Health Management Network Commercial	$343.40
Rate for Payer: Kaiser Permanente Commercial	$363.60
Rate for Payer: MDX Hawaii PPO	$391.88

69209-Cerumen Irrigation/Lavage

Facility

$404.00

Service Code	HCPCS 69209
Hospital Charge Code	8080148
Hospital Revenue Code	450
Min. Negotiated Rate	$202.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$202.00
Rate for Payer: Cash Price	$262.60
Rate for Payer: Cash Price	$262.60
Rate for Payer: Cash Price	$262.60
Rate for Payer: Devoted Health Medicare	$222.20
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$202.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$383.80
Rate for Payer: Health Management Network Commercial	$343.40
Rate for Payer: Humana Medicare	$202.00
Rate for Payer: Kaiser Permanente Commercial	$363.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$202.00
Rate for Payer: MDX Hawaii PPO	$391.88
Rate for Payer: Ohana Health Plan Medicaid	$202.00
Rate for Payer: Ohana Health Plan Medicare	$202.00
Rate for Payer: UnitedHealthcare Medicare	$202.00
Rate for Payer: University Health Alliance Commercial	$294.48

69210-Cerumen w/ Instrumentation

Facility

$330.00

Service Code	HCPCS 69210
Hospital Charge Code	8080150
Hospital Revenue Code	450
Min. Negotiated Rate	$280.50
Max. Negotiated Rate	$320.10
Rate for Payer: Cash Price	$214.50
Rate for Payer: Health Management Network Commercial	$280.50
Rate for Payer: Kaiser Permanente Commercial	$297.00
Rate for Payer: MDX Hawaii PPO	$320.10

Know your out-of-pocket cost for care.

All Charges