Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

92511 Nasopharyngoscopy with endoscope

Facility

$1,093.00

Service Code	HCPCS 92511
Hospital Charge Code	11043542
Hospital Revenue Code	450
Min. Negotiated Rate	$929.05
Max. Negotiated Rate	$1,060.21
Rate for Payer: Cash Price	$710.45
Rate for Payer: Health Management Network Commercial	$929.05
Rate for Payer: Kaiser Permanente Commercial	$983.70
Rate for Payer: MDX Hawaii PPO	$1,060.21

92526 Swallowing Treatment Feeding

Facility

$533.00

Service Code	HCPCS 92526 GP,CQ
Hospital Charge Code	8222666
Hospital Revenue Code	430
Min. Negotiated Rate	$22.46
Max. Negotiated Rate	$517.01
Rate for Payer: AlohaCare Medicaid	$266.50
Rate for Payer: AlohaCare Medicare	$266.50
Rate for Payer: Cash Price	$346.45
Rate for Payer: Cash Price	$346.45
Rate for Payer: Devoted Health Medicare	$293.15
Rate for Payer: Hawaii Medical Service Association Medicare	$266.50
Rate for Payer: Hawaii Western Management Group Commercial	$506.35
Rate for Payer: Health Management Network Commercial	$453.05
Rate for Payer: Humana Medicare	$266.50
Rate for Payer: Kaiser Permanente Commercial	$479.70
Rate for Payer: Kaiser Permanente Medicaid	$271.83
Rate for Payer: Kaiser Permanente Medicare	$266.50
Rate for Payer: MDX Hawaii PPO	$517.01
Rate for Payer: Ohana Health Plan Medicaid	$266.50
Rate for Payer: Ohana Health Plan Medicare	$266.50
Rate for Payer: UnitedHealthcare Medicaid	$22.46
Rate for Payer: UnitedHealthcare Medicare	$266.50
Rate for Payer: University Health Alliance Commercial	$388.50

92526 Swallowing Treatment Feeding

Facility

$533.00

Service Code	HCPCS 92526 GP,CQ
Hospital Charge Code	8222666
Hospital Revenue Code	430
Min. Negotiated Rate	$453.05
Max. Negotiated Rate	$517.01
Rate for Payer: Cash Price	$346.45
Rate for Payer: Health Management Network Commercial	$453.05
Rate for Payer: Kaiser Permanente Commercial	$479.70
Rate for Payer: MDX Hawaii PPO	$517.01

92586 NEWBORN HEARING SCREEN ABR CHARGE

Facility

$536.00

Service Code	HCPCS 92650
Hospital Charge Code	8140435
Hospital Revenue Code	471
Min. Negotiated Rate	$19.16
Max. Negotiated Rate	$519.92
Rate for Payer: AlohaCare Medicaid	$268.00
Rate for Payer: AlohaCare Medicare	$268.00
Rate for Payer: Cash Price	$348.40
Rate for Payer: Cash Price	$348.40
Rate for Payer: Devoted Health Medicare	$294.80
Rate for Payer: Hawaii Medical Service Association Medicare	$268.00
Rate for Payer: Hawaii Western Management Group Commercial	$509.20
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Humana Medicare	$268.00
Rate for Payer: Kaiser Permanente Commercial	$482.40
Rate for Payer: Kaiser Permanente Medicaid	$273.36
Rate for Payer: Kaiser Permanente Medicare	$268.00
Rate for Payer: MDX Hawaii PPO	$519.92
Rate for Payer: Ohana Health Plan Medicaid	$268.00
Rate for Payer: Ohana Health Plan Medicare	$268.00
Rate for Payer: UnitedHealthcare Medicaid	$19.16
Rate for Payer: UnitedHealthcare Medicare	$268.00
Rate for Payer: University Health Alliance Commercial	$390.69

92586 NEWBORN HEARING SCREEN ABR CHARGE

Facility

$536.00

Service Code	HCPCS 92650
Hospital Charge Code	8140435
Hospital Revenue Code	471
Min. Negotiated Rate	$455.60
Max. Negotiated Rate	$519.92
Rate for Payer: Cash Price	$348.40
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Kaiser Permanente Commercial	$482.40
Rate for Payer: MDX Hawaii PPO	$519.92

92587 NEWBORN HEARING SCREEN OAE CHARGE

Facility

$634.00

Service Code	HCPCS 92587
Hospital Charge Code	8083985
Hospital Revenue Code	471
Min. Negotiated Rate	$43.74
Max. Negotiated Rate	$614.98
Rate for Payer: AlohaCare Medicaid	$317.00
Rate for Payer: AlohaCare Medicare	$317.00
Rate for Payer: Cash Price	$412.10
Rate for Payer: Cash Price	$412.10
Rate for Payer: Devoted Health Medicare	$348.70
Rate for Payer: Hawaii Medical Service Association ABD	$43.74
Rate for Payer: Hawaii Medical Service Association Commercial	$275.75
Rate for Payer: Hawaii Medical Service Association Medicare	$317.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$47.25
Rate for Payer: Hawaii Western Management Group Commercial	$602.30
Rate for Payer: Health Management Network Commercial	$538.90
Rate for Payer: Humana Medicare	$317.00
Rate for Payer: Kaiser Permanente Commercial	$570.60
Rate for Payer: Kaiser Permanente Medicaid	$323.34
Rate for Payer: Kaiser Permanente Medicare	$317.00
Rate for Payer: MDX Hawaii PPO	$614.98
Rate for Payer: Ohana Health Plan Medicaid	$317.00
Rate for Payer: Ohana Health Plan Medicare	$317.00
Rate for Payer: UnitedHealthcare Medicaid	$43.74
Rate for Payer: UnitedHealthcare Medicare	$317.00
Rate for Payer: University Health Alliance Commercial	$462.12

92587 NEWBORN HEARING SCREEN OAE CHARGE

Facility

$634.00

Service Code	HCPCS 92587
Hospital Charge Code	8083985
Hospital Revenue Code	471
Min. Negotiated Rate	$538.90
Max. Negotiated Rate	$614.98
Rate for Payer: Cash Price	$412.10
Rate for Payer: Health Management Network Commercial	$538.90
Rate for Payer: Kaiser Permanente Commercial	$570.60
Rate for Payer: MDX Hawaii PPO	$614.98

92950-Cardiopulmonary Resuscitation

Facility

$1,249.00

Service Code	HCPCS 92950
Hospital Charge Code	8080174
Hospital Revenue Code	450
Min. Negotiated Rate	$1,061.65
Max. Negotiated Rate	$1,211.53
Rate for Payer: Cash Price	$811.85
Rate for Payer: Health Management Network Commercial	$1,061.65
Rate for Payer: Kaiser Permanente Commercial	$1,124.10
Rate for Payer: MDX Hawaii PPO	$1,211.53

92950-Cardiopulmonary Resuscitation

Facility

$1,249.00

Service Code	HCPCS 92950
Hospital Charge Code	8080174
Hospital Revenue Code	450
Min. Negotiated Rate	$525.09
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$624.50
Rate for Payer: Cash Price	$811.85
Rate for Payer: Cash Price	$811.85
Rate for Payer: Cash Price	$811.85
Rate for Payer: Devoted Health Medicare	$686.95
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	$624.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,186.55
Rate for Payer: Health Management Network Commercial	$1,061.65
Rate for Payer: Humana Medicare	$624.50
Rate for Payer: Kaiser Permanente Commercial	$1,124.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$624.50
Rate for Payer: MDX Hawaii PPO	$1,211.53
Rate for Payer: Ohana Health Plan Medicaid	$624.50
Rate for Payer: Ohana Health Plan Medicare	$624.50
Rate for Payer: UnitedHealthcare Medicare	$624.50
Rate for Payer: University Health Alliance Commercial	$910.40

92950 CPR CODE BLUE CHARGE CHARGE

Facility

$1,249.00

Service Code	HCPCS 92950
Hospital Charge Code	8408953
Hospital Revenue Code	480
Min. Negotiated Rate	$1,061.65
Max. Negotiated Rate	$1,211.53
Rate for Payer: Cash Price	$811.85
Rate for Payer: Health Management Network Commercial	$1,061.65
Rate for Payer: Kaiser Permanente Commercial	$1,124.10
Rate for Payer: MDX Hawaii PPO	$1,211.53

92950 CPR CODE BLUE CHARGE CHARGE

Facility

$1,249.00

Service Code	HCPCS 92950
Hospital Charge Code	8408953
Hospital Revenue Code	480
Min. Negotiated Rate	$168.25
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$624.50
Rate for Payer: AlohaCare Medicare	$624.50
Rate for Payer: Cash Price	$811.85
Rate for Payer: Cash Price	$811.85
Rate for Payer: Cash Price	$811.85
Rate for Payer: Devoted Health Medicare	$686.95
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	$624.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,186.55
Rate for Payer: Health Management Network Commercial	$1,061.65
Rate for Payer: Humana Medicare	$624.50
Rate for Payer: Kaiser Permanente Commercial	$1,124.10
Rate for Payer: Kaiser Permanente Medicaid	$636.99
Rate for Payer: Kaiser Permanente Medicare	$624.50
Rate for Payer: MDX Hawaii PPO	$1,211.53
Rate for Payer: Ohana Health Plan Medicaid	$624.50
Rate for Payer: Ohana Health Plan Medicare	$624.50
Rate for Payer: UnitedHealthcare Medicaid	$168.25
Rate for Payer: UnitedHealthcare Medicare	$624.50
Rate for Payer: University Health Alliance Commercial	$910.40

92953 Temporary External Pacing TechFee

Facility

$1,491.00

Service Code	HCPCS 92953
Hospital Charge Code	8343985
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	$745.50
Rate for Payer: Cash Price	$969.15
Rate for Payer: Cash Price	$969.15
Rate for Payer: Cash Price	$969.15
Rate for Payer: Devoted Health Medicare	$820.05
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	$745.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,416.45
Rate for Payer: Health Management Network Commercial	$1,267.35
Rate for Payer: Humana Medicare	$745.50
Rate for Payer: Kaiser Permanente Commercial	$1,341.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$745.50
Rate for Payer: MDX Hawaii PPO	$1,446.27
Rate for Payer: Ohana Health Plan Medicaid	$745.50
Rate for Payer: Ohana Health Plan Medicare	$745.50
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$745.50
Rate for Payer: University Health Alliance Commercial	$1,086.79

92953 Temporary External Pacing TechFee

Facility

$1,491.00

Service Code	HCPCS 92953
Hospital Charge Code	8343985
Hospital Revenue Code	450
Min. Negotiated Rate	$1,267.35
Max. Negotiated Rate	$1,446.27
Rate for Payer: Cash Price	$969.15
Rate for Payer: Health Management Network Commercial	$1,267.35
Rate for Payer: Kaiser Permanente Commercial	$1,341.90
Rate for Payer: MDX Hawaii PPO	$1,446.27

92953 Temporary transcutaneous pacing.

Facility

$4,117.00

Service Code	HCPCS 92953
Hospital Charge Code	8743020
Hospital Revenue Code	450
Min. Negotiated Rate	$3,499.45
Max. Negotiated Rate	$3,993.49
Rate for Payer: Cash Price	$2,676.05
Rate for Payer: Health Management Network Commercial	$3,499.45
Rate for Payer: Kaiser Permanente Commercial	$3,705.30
Rate for Payer: MDX Hawaii PPO	$3,993.49

92953 Temporary transcutaneous pacing.

Facility

$4,117.00

Service Code	HCPCS 92953
Hospital Charge Code	8743020
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,993.49
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$2,058.50
Rate for Payer: Cash Price	$2,676.05
Rate for Payer: Cash Price	$2,676.05
Rate for Payer: Cash Price	$2,676.05
Rate for Payer: Devoted Health Medicare	$2,264.35
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	$2,058.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,911.15
Rate for Payer: Health Management Network Commercial	$3,499.45
Rate for Payer: Humana Medicare	$2,058.50
Rate for Payer: Kaiser Permanente Commercial	$3,705.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,058.50
Rate for Payer: MDX Hawaii PPO	$3,993.49
Rate for Payer: Ohana Health Plan Medicaid	$2,058.50
Rate for Payer: Ohana Health Plan Medicare	$2,058.50
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$2,058.50
Rate for Payer: University Health Alliance Commercial	$3,000.88

92960 - Cardioversion; Elective

Facility

$2,653.00

Service Code	HCPCS 92960
Hospital Charge Code	8080175
Hospital Revenue Code	761
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$1,326.50
Rate for Payer: AlohaCare Medicare	$1,326.50
Rate for Payer: Cash Price	$1,724.45
Rate for Payer: Cash Price	$1,724.45
Rate for Payer: Devoted Health Medicare	$1,459.15
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	$1,326.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$2,520.35
Rate for Payer: Health Management Network Commercial	$2,255.05
Rate for Payer: Humana Medicare	$1,326.50
Rate for Payer: Kaiser Permanente Commercial	$2,387.70
Rate for Payer: Kaiser Permanente Medicaid	$1,353.03
Rate for Payer: Kaiser Permanente Medicare	$1,326.50
Rate for Payer: MDX Hawaii PPO	$2,573.41
Rate for Payer: Ohana Health Plan Medicaid	$1,326.50
Rate for Payer: Ohana Health Plan Medicare	$1,326.50
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,326.50
Rate for Payer: University Health Alliance Commercial	$4,035.20

92960 - Cardioversion; Elective

Facility

$2,653.00

Service Code	HCPCS 92960
Hospital Charge Code	8080175
Hospital Revenue Code	761
Min. Negotiated Rate	$2,255.05
Max. Negotiated Rate	$2,573.41
Rate for Payer: Cash Price	$1,724.45
Rate for Payer: Health Management Network Commercial	$2,255.05
Rate for Payer: Kaiser Permanente Commercial	$2,387.70
Rate for Payer: MDX Hawaii PPO	$2,573.41

92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL TechFee

Facility

$3,166.00

Service Code	HCPCS 92960
Hospital Charge Code	8211358
Hospital Revenue Code	450
Min. Negotiated Rate	$2,691.10
Max. Negotiated Rate	$3,071.02
Rate for Payer: Cash Price	$2,057.90
Rate for Payer: Health Management Network Commercial	$2,691.10
Rate for Payer: Kaiser Permanente Commercial	$2,849.40
Rate for Payer: MDX Hawaii PPO	$3,071.02

92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL TechFee

Facility

$3,166.00

Service Code	HCPCS 92960
Hospital Charge Code	8211358
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$1,583.00
Rate for Payer: Cash Price	$2,057.90
Rate for Payer: Cash Price	$2,057.90
Rate for Payer: Cash Price	$2,057.90
Rate for Payer: Devoted Health Medicare	$1,741.30
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	$1,583.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$3,007.70
Rate for Payer: Health Management Network Commercial	$2,691.10
Rate for Payer: Humana Medicare	$1,583.00
Rate for Payer: Kaiser Permanente Commercial	$2,849.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,583.00
Rate for Payer: MDX Hawaii PPO	$3,071.02
Rate for Payer: Ohana Health Plan Medicaid	$1,583.00
Rate for Payer: Ohana Health Plan Medicare	$1,583.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,583.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

92960 CARDIOVERSION - ER SERV PROCEDURE

Professional

Both

$1,037.00

Service Code	HCPCS 92960
Hospital Charge Code	8051096
Hospital Revenue Code	975
Min. Negotiated Rate	$96.14
Max. Negotiated Rate	$881.45
Rate for Payer: AlohaCare Medicaid	$108.77
Rate for Payer: AlohaCare Medicare	$96.14
Rate for Payer: Cash Price	$674.05
Rate for Payer: Cash Price	$674.05
Rate for Payer: Devoted Health Medicare	$105.75
Rate for Payer: Hawaii Medical Service Association ABD	$108.77
Rate for Payer: Hawaii Medical Service Association Medicare	$96.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$108.77
Rate for Payer: Hawaii Western Management Group Commercial	$155.52
Rate for Payer: Health Management Network Commercial	$881.45
Rate for Payer: Kaiser Permanente Commercial	$105.75
Rate for Payer: Kaiser Permanente Medicaid	$105.75
Rate for Payer: Kaiser Permanente Medicare	$105.75
Rate for Payer: Ohana Health Plan Medicaid	$108.77
Rate for Payer: Ohana Health Plan Medicare	$96.14
Rate for Payer: UnitedHealthcare Medicaid	$108.77
Rate for Payer: UnitedHealthcare Medicare	$96.14
Rate for Payer: University Health Alliance Commercial	$135.15

93005-ED EKG

Facility

$370.00

Service Code	HCPCS 93005
Hospital Charge Code	8080242
Hospital Revenue Code	732
Min. Negotiated Rate	$314.50
Max. Negotiated Rate	$358.90
Rate for Payer: Cash Price	$240.50
Rate for Payer: Health Management Network Commercial	$314.50
Rate for Payer: Kaiser Permanente Commercial	$333.00
Rate for Payer: MDX Hawaii PPO	$358.90

93005-ED EKG

Facility

$370.00

Service Code	HCPCS 93005
Hospital Charge Code	8080242
Hospital Revenue Code	732
Min. Negotiated Rate	$15.16
Max. Negotiated Rate	$358.90
Rate for Payer: AlohaCare Medicaid	$185.00
Rate for Payer: AlohaCare Medicare	$185.00
Rate for Payer: Cash Price	$240.50
Rate for Payer: Cash Price	$240.50
Rate for Payer: Devoted Health Medicare	$203.50
Rate for Payer: Hawaii Medical Service Association Commercial	$75.34
Rate for Payer: Hawaii Medical Service Association Medicare	$185.00
Rate for Payer: Hawaii Western Management Group Commercial	$351.50
Rate for Payer: Health Management Network Commercial	$314.50
Rate for Payer: Humana Medicare	$185.00
Rate for Payer: Kaiser Permanente Commercial	$333.00
Rate for Payer: Kaiser Permanente Medicaid	$188.70
Rate for Payer: Kaiser Permanente Medicare	$185.00
Rate for Payer: MDX Hawaii PPO	$358.90
Rate for Payer: Ohana Health Plan Medicaid	$185.00
Rate for Payer: Ohana Health Plan Medicare	$185.00
Rate for Payer: UnitedHealthcare Medicaid	$15.16
Rate for Payer: UnitedHealthcare Medicare	$185.00
Rate for Payer: University Health Alliance Commercial	$269.69

93005 EKG Tracing Only Addl Charge

Facility

$400.00

Service Code	HCPCS 93005 76
Hospital Charge Code	8220605
Hospital Revenue Code	730
Min. Negotiated Rate	$340.00
Max. Negotiated Rate	$388.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Kaiser Permanente Commercial	$360.00
Rate for Payer: MDX Hawaii PPO	$388.00

93005 EKG Tracing Only Addl Charge

Facility

$400.00

Service Code	HCPCS 93005 76
Hospital Charge Code	8220605
Hospital Revenue Code	730
Min. Negotiated Rate	$15.16
Max. Negotiated Rate	$388.00
Rate for Payer: AlohaCare Medicaid	$200.00
Rate for Payer: AlohaCare Medicare	$200.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Devoted Health Medicare	$220.00
Rate for Payer: Hawaii Medical Service Association Medicare	$200.00
Rate for Payer: Hawaii Western Management Group Commercial	$380.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Humana Medicare	$200.00
Rate for Payer: Kaiser Permanente Commercial	$360.00
Rate for Payer: Kaiser Permanente Medicaid	$204.00
Rate for Payer: Kaiser Permanente Medicare	$200.00
Rate for Payer: MDX Hawaii PPO	$388.00
Rate for Payer: Ohana Health Plan Medicaid	$200.00
Rate for Payer: Ohana Health Plan Medicare	$200.00
Rate for Payer: UnitedHealthcare Medicaid	$15.16
Rate for Payer: UnitedHealthcare Medicare	$200.00
Rate for Payer: University Health Alliance Commercial	$291.56

93005 EKG Tracing Only Charge

Facility

$400.00

Service Code	HCPCS 93005
Hospital Charge Code	8220760
Hospital Revenue Code	730
Min. Negotiated Rate	$340.00
Max. Negotiated Rate	$388.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Kaiser Permanente Commercial	$360.00
Rate for Payer: MDX Hawaii PPO	$388.00

Know your out-of-pocket cost for care.

All Charges