Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC BRONCHOSCOPY,REMV FOR. BODY

Facility

$6,720.00

Service Code	HCPCS 31635
Hospital Charge Code	7613163501
Hospital Revenue Code	450
Min. Negotiated Rate	$5,712.00
Max. Negotiated Rate	$6,518.40
Rate for Payer: Cash Price	$4,032.00
Rate for Payer: Health Management Network Commercial	$5,712.00
Rate for Payer: MDX Hawaii PPO	$6,518.40

HC BRONCHOSPSM PRE/POST EVAL

Facility

$1,239.00

Service Code	HCPCS 94060
Hospital Charge Code	4609406001
Hospital Revenue Code	460
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$1,201.83
Rate for Payer: AlohaCare Medicaid	$440.83
Rate for Payer: AlohaCare Medicare	$440.83
Rate for Payer: Cash Price	$743.40
Rate for Payer: Cash Price	$743.40
Rate for Payer: Devoted Health Medicare	$484.91
Rate for Payer: Hawaii Medical Service Association ABD	$31.20
Rate for Payer: Hawaii Medical Service Association Commercial	$551.04
Rate for Payer: Hawaii Medical Service Association Medicare	$440.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$32.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,177.05
Rate for Payer: Health Management Network Commercial	$1,053.15
Rate for Payer: Humana Medicare	$440.83
Rate for Payer: Kaiser Permanente Commercial	$780.57
Rate for Payer: Kaiser Permanente Medicaid	$631.89
Rate for Payer: Kaiser Permanente Medicare	$440.83
Rate for Payer: MDX Hawaii PPO	$1,201.83
Rate for Payer: Ohana Health Plan Medicaid	$484.91
Rate for Payer: Ohana Health Plan Medicare	$440.83
Rate for Payer: UnitedHealthcare Medicaid	$31.20
Rate for Payer: UnitedHealthcare Medicare	$440.83
Rate for Payer: University Health Alliance Commercial	$903.11

HC BRONCHOSPSM PRE/POST EVAL

Facility

$1,239.00

Service Code	HCPCS 94060
Hospital Charge Code	4609406001
Hospital Revenue Code	460
Min. Negotiated Rate	$1,053.15
Max. Negotiated Rate	$1,201.83
Rate for Payer: Cash Price	$743.40
Rate for Payer: Health Management Network Commercial	$1,053.15
Rate for Payer: MDX Hawaii PPO	$1,201.83

HC BRUCELLA, ANTIBODY - BRUCELLA SPECIES ANTIBODY

Facility

$75.00

Service Code	HCPCS 86622
Hospital Charge Code	3028662201
Hospital Revenue Code	302
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$72.75
Rate for Payer: AlohaCare Medicaid	$8.93
Rate for Payer: AlohaCare Medicare	$8.93
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Devoted Health Medicare	$9.82
Rate for Payer: Hawaii Medical Service Association ABD	$12.35
Rate for Payer: Hawaii Medical Service Association Commercial	$11.16
Rate for Payer: Hawaii Medical Service Association Medicare	$8.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.97
Rate for Payer: Hawaii Western Management Group Commercial	$8.93
Rate for Payer: Health Management Network Commercial	$63.75
Rate for Payer: Humana Medicare	$8.93
Rate for Payer: Kaiser Permanente Commercial	$47.25
Rate for Payer: Kaiser Permanente Medicaid	$38.25
Rate for Payer: Kaiser Permanente Medicare	$8.93
Rate for Payer: MDX Hawaii PPO	$72.75
Rate for Payer: Ohana Health Plan Medicaid	$9.82
Rate for Payer: Ohana Health Plan Medicare	$8.93
Rate for Payer: UnitedHealthcare Medicaid	$12.35
Rate for Payer: UnitedHealthcare Medicare	$8.93
Rate for Payer: University Health Alliance Commercial	$23.09

HC BRUCELLA, ANTIBODY - BRUCELLA SPECIES ANTIBODY

Facility

$75.00

Service Code	HCPCS 86622
Hospital Charge Code	3028662201
Hospital Revenue Code	302
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$72.75
Rate for Payer: Cash Price	$45.00
Rate for Payer: Health Management Network Commercial	$63.75
Rate for Payer: MDX Hawaii PPO	$72.75

HC BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE

Facility

$6,448.00

Service Code	HCPCS 19083
Hospital Charge Code	3611908301
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$6,254.56
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Commercial	$4,062.24
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: MDX Hawaii PPO	$6,254.56
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE

Facility

$6,448.00

Service Code	HCPCS 19083
Hospital Charge Code	3611908301
Hospital Revenue Code	361
Min. Negotiated Rate	$5,480.80
Max. Negotiated Rate	$6,254.56
Rate for Payer: Cash Price	$3,868.80
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: MDX Hawaii PPO	$6,254.56

HC BX PROSTATE IN-BORE CT/MRI BX ADDL TRGT LES 1ST

Facility

$18,461.00

Service Code	HCPCS 55713
Hospital Charge Code	3615571301
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$17,907.17
Rate for Payer: AlohaCare Medicaid	$6,334.13
Rate for Payer: AlohaCare Medicare	$6,334.13
Rate for Payer: Cash Price	$11,076.60
Rate for Payer: Cash Price	$11,076.60
Rate for Payer: Cash Price	$11,076.60
Rate for Payer: Devoted Health Medicare	$6,967.54
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	$6,334.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$15,691.85
Rate for Payer: Humana Medicare	$6,334.13
Rate for Payer: Kaiser Permanente Commercial	$11,630.43
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,334.13
Rate for Payer: MDX Hawaii PPO	$17,907.17
Rate for Payer: Ohana Health Plan Medicaid	$6,967.54
Rate for Payer: Ohana Health Plan Medicare	$6,334.13
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$6,334.13
Rate for Payer: University Health Alliance Commercial	$13,456.22

HC BX PROSTATE IN-BORE CT/MRI BX ADDL TRGT LES 1ST

Facility

$18,461.00

Service Code	HCPCS 55713
Hospital Charge Code	3615571301
Hospital Revenue Code	361
Min. Negotiated Rate	$15,691.85
Max. Negotiated Rate	$17,907.17
Rate for Payer: Cash Price	$11,076.60
Rate for Payer: Health Management Network Commercial	$15,691.85
Rate for Payer: MDX Hawaii PPO	$17,907.17

HC BX PROSTATE IN-BORE CT/MRI TRGT LES ONLY 1ST

Facility

$18,461.00

Service Code	HCPCS 55714
Hospital Charge Code	3615571401
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$17,907.17
Rate for Payer: AlohaCare Medicaid	$6,334.13
Rate for Payer: AlohaCare Medicare	$6,334.13
Rate for Payer: Cash Price	$11,076.60
Rate for Payer: Cash Price	$11,076.60
Rate for Payer: Cash Price	$11,076.60
Rate for Payer: Devoted Health Medicare	$6,967.54
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	$6,334.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$15,691.85
Rate for Payer: Humana Medicare	$6,334.13
Rate for Payer: Kaiser Permanente Commercial	$11,630.43
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,334.13
Rate for Payer: MDX Hawaii PPO	$17,907.17
Rate for Payer: Ohana Health Plan Medicaid	$6,967.54
Rate for Payer: Ohana Health Plan Medicare	$6,334.13
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$6,334.13
Rate for Payer: University Health Alliance Commercial	$13,456.22

HC BX PROSTATE IN-BORE CT/MRI TRGT LES ONLY 1ST

Facility

$18,461.00

Service Code	HCPCS 55714
Hospital Charge Code	3615571401
Hospital Revenue Code	361
Min. Negotiated Rate	$15,691.85
Max. Negotiated Rate	$17,907.17
Rate for Payer: Cash Price	$11,076.60
Rate for Payer: Health Management Network Commercial	$15,691.85
Rate for Payer: MDX Hawaii PPO	$17,907.17

HC BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID

Facility

$12,136.00

Service Code	HCPCS 55706
Hospital Charge Code	3615570601
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,771.92
Rate for Payer: AlohaCare Medicaid	$4,164.22
Rate for Payer: AlohaCare Medicare	$4,164.22
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Devoted Health Medicare	$4,580.64
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	$4,164.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$10,315.60
Rate for Payer: Humana Medicare	$4,164.22
Rate for Payer: Kaiser Permanente Commercial	$7,645.68
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,164.22
Rate for Payer: MDX Hawaii PPO	$11,771.92
Rate for Payer: Ohana Health Plan Medicaid	$4,580.64
Rate for Payer: Ohana Health Plan Medicare	$4,164.22
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,164.22
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID

Facility

$12,136.00

Service Code	HCPCS 55706
Hospital Charge Code	3615570601
Hospital Revenue Code	361
Min. Negotiated Rate	$10,315.60
Max. Negotiated Rate	$11,771.92
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Health Management Network Commercial	$10,315.60
Rate for Payer: MDX Hawaii PPO	$11,771.92

HC BX PROSTATE TPRNL MRI-US GID TRGT LES 1ST

Facility

$12,136.00

Service Code	HCPCS 55712
Hospital Charge Code	3615571201
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,771.92
Rate for Payer: AlohaCare Medicaid	$4,164.22
Rate for Payer: AlohaCare Medicare	$4,164.22
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Devoted Health Medicare	$4,580.64
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	$4,164.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$10,315.60
Rate for Payer: Humana Medicare	$4,164.22
Rate for Payer: Kaiser Permanente Commercial	$7,645.68
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,164.22
Rate for Payer: MDX Hawaii PPO	$11,771.92
Rate for Payer: Ohana Health Plan Medicaid	$4,580.64
Rate for Payer: Ohana Health Plan Medicare	$4,164.22
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,164.22
Rate for Payer: University Health Alliance Commercial	$8,845.93

HC BX PROSTATE TPRNL MRI-US GID TRGT LES 1ST

Facility

$12,136.00

Service Code	HCPCS 55712
Hospital Charge Code	3615571201
Hospital Revenue Code	361
Min. Negotiated Rate	$10,315.60
Max. Negotiated Rate	$11,771.92
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Health Management Network Commercial	$10,315.60
Rate for Payer: MDX Hawaii PPO	$11,771.92

HC BX PROSTATE TRANSPERINEAL ULTRASOUND-GUIDED

Facility

$12,136.00

Service Code	HCPCS 55709
Hospital Charge Code	3615570901
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,771.92
Rate for Payer: AlohaCare Medicaid	$4,164.22
Rate for Payer: AlohaCare Medicare	$4,164.22
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Devoted Health Medicare	$4,580.64
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	$4,164.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$10,315.60
Rate for Payer: Humana Medicare	$4,164.22
Rate for Payer: Kaiser Permanente Commercial	$7,645.68
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,164.22
Rate for Payer: MDX Hawaii PPO	$11,771.92
Rate for Payer: Ohana Health Plan Medicaid	$4,580.64
Rate for Payer: Ohana Health Plan Medicare	$4,164.22
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,164.22
Rate for Payer: University Health Alliance Commercial	$8,845.93

HC BX PROSTATE TRANSPERINEAL ULTRASOUND-GUIDED

Facility

$12,136.00

Service Code	HCPCS 55709
Hospital Charge Code	3615570901
Hospital Revenue Code	361
Min. Negotiated Rate	$10,315.60
Max. Negotiated Rate	$11,771.92
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Health Management Network Commercial	$10,315.60
Rate for Payer: MDX Hawaii PPO	$11,771.92

HC BX PROSTATE TRANSPERINEAL US GID W/MRI FUS GDN 1

Facility

$12,136.00

Service Code	HCPCS 55710
Hospital Charge Code	3615571001
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,771.92
Rate for Payer: AlohaCare Medicaid	$4,164.22
Rate for Payer: AlohaCare Medicare	$4,164.22
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Devoted Health Medicare	$4,580.64
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	$4,164.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$10,315.60
Rate for Payer: Humana Medicare	$4,164.22
Rate for Payer: Kaiser Permanente Commercial	$7,645.68
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,164.22
Rate for Payer: MDX Hawaii PPO	$11,771.92
Rate for Payer: Ohana Health Plan Medicaid	$4,580.64
Rate for Payer: Ohana Health Plan Medicare	$4,164.22
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,164.22
Rate for Payer: University Health Alliance Commercial	$8,845.93

HC BX PROSTATE TRANSPERINEAL US GID W/MRI FUS GDN 1

Facility

$12,136.00

Service Code	HCPCS 55710
Hospital Charge Code	3615571001
Hospital Revenue Code	361
Min. Negotiated Rate	$10,315.60
Max. Negotiated Rate	$11,771.92
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Health Management Network Commercial	$10,315.60
Rate for Payer: MDX Hawaii PPO	$11,771.92

HC BX PROSTATE TRANSRECTAL MRI-US GID TRGT LES 1ST

Facility

$12,136.00

Service Code	HCPCS 55711
Hospital Charge Code	3615571101
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,771.92
Rate for Payer: AlohaCare Medicaid	$4,164.22
Rate for Payer: AlohaCare Medicare	$4,164.22
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Devoted Health Medicare	$4,580.64
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	$4,164.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$10,315.60
Rate for Payer: Humana Medicare	$4,164.22
Rate for Payer: Kaiser Permanente Commercial	$7,645.68
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,164.22
Rate for Payer: MDX Hawaii PPO	$11,771.92
Rate for Payer: Ohana Health Plan Medicaid	$4,580.64
Rate for Payer: Ohana Health Plan Medicare	$4,164.22
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,164.22
Rate for Payer: University Health Alliance Commercial	$8,845.93

HC BX PROSTATE TRANSRECTAL MRI-US GID TRGT LES 1ST

Facility

$12,136.00

Service Code	HCPCS 55711
Hospital Charge Code	3615571101
Hospital Revenue Code	361
Min. Negotiated Rate	$10,315.60
Max. Negotiated Rate	$11,771.92
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Health Management Network Commercial	$10,315.60
Rate for Payer: MDX Hawaii PPO	$11,771.92

HC BX PROSTATE TRANSRECTAL US GID W/MRI FUS GDN 1ST

Facility

$12,136.00

Service Code	HCPCS 55708
Hospital Charge Code	3615570801
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,771.92
Rate for Payer: AlohaCare Medicaid	$4,164.22
Rate for Payer: AlohaCare Medicare	$4,164.22
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Devoted Health Medicare	$4,580.64
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	$4,164.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$10,315.60
Rate for Payer: Humana Medicare	$4,164.22
Rate for Payer: Kaiser Permanente Commercial	$7,645.68
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,164.22
Rate for Payer: MDX Hawaii PPO	$11,771.92
Rate for Payer: Ohana Health Plan Medicaid	$4,580.64
Rate for Payer: Ohana Health Plan Medicare	$4,164.22
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,164.22
Rate for Payer: University Health Alliance Commercial	$8,845.93

HC BX PROSTATE TRANSRECTAL US GID W/MRI FUS GDN 1ST

Facility

$12,136.00

Service Code	HCPCS 55708
Hospital Charge Code	3615570801
Hospital Revenue Code	361
Min. Negotiated Rate	$10,315.60
Max. Negotiated Rate	$11,771.92
Rate for Payer: Cash Price	$7,281.60
Rate for Payer: Health Management Network Commercial	$10,315.60
Rate for Payer: MDX Hawaii PPO	$11,771.92

HC BX SKIN PUNCH LESION ADDL

Facility

$1,136.00

Service Code	HCPCS 11105
Hospital Charge Code	3611110501
Hospital Revenue Code	361
Min. Negotiated Rate	$25.66
Max. Negotiated Rate	$2,837.00
Rate for Payer: Cash Price	$681.60
Rate for Payer: Cash Price	$681.60
Rate for Payer: Cash Price	$681.60
Rate for Payer: Health Management Network Commercial	$965.60
Rate for Payer: Kaiser Permanente Commercial	$715.68
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: MDX Hawaii PPO	$1,101.92
Rate for Payer: UnitedHealthcare Medicaid	$25.66
Rate for Payer: University Health Alliance Commercial	$828.03

HC BX SKIN PUNCH LESION ADDL

Facility

$1,136.00

Service Code	HCPCS 11105
Hospital Charge Code	3611110501
Hospital Revenue Code	361
Min. Negotiated Rate	$965.60
Max. Negotiated Rate	$1,101.92
Rate for Payer: Cash Price	$681.60
Rate for Payer: Health Management Network Commercial	$965.60
Rate for Payer: MDX Hawaii PPO	$1,101.92

Know your out-of-pocket cost for care.

All Charges