Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

HC EP UPGRADE OF PACEMAKER SYSTEM

Facility

$52,060.00

Service Code	HCPCS 33214
Hospital Charge Code	4803321401
Hospital Revenue Code	480
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$50,498.20
Rate for Payer: AlohaCare Medicaid	$12,347.41
Rate for Payer: AlohaCare Medicare	$12,347.41
Rate for Payer: Cash Price	$31,236.00
Rate for Payer: Cash Price	$31,236.00
Rate for Payer: Cash Price	$31,236.00
Rate for Payer: Devoted Health Medicare	$13,582.15
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$12,347.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Hawaii Western Management Group Commercial	$49,457.00
Rate for Payer: Health Management Network Commercial	$44,251.00
Rate for Payer: Humana Medicare	$12,347.41
Rate for Payer: Kaiser Permanente Commercial	$32,797.80
Rate for Payer: Kaiser Permanente Medicaid	$26,550.60
Rate for Payer: Kaiser Permanente Medicare	$12,347.41
Rate for Payer: MDX Hawaii PPO	$50,498.20
Rate for Payer: Ohana Health Plan Medicaid	$13,582.15
Rate for Payer: Ohana Health Plan Medicare	$12,347.41
Rate for Payer: UnitedHealthcare Medicaid	$644.55
Rate for Payer: UnitedHealthcare Medicare	$12,347.41
Rate for Payer: University Health Alliance Commercial	$37,946.53

HC EP UPGRADE OF PACEMAKER SYSTEM

Facility

$52,060.00

Service Code	HCPCS 33214
Hospital Charge Code	4803321401
Hospital Revenue Code	480
Min. Negotiated Rate	$44,251.00
Max. Negotiated Rate	$50,498.20
Rate for Payer: Cash Price	$31,236.00
Rate for Payer: Health Management Network Commercial	$44,251.00
Rate for Payer: MDX Hawaii PPO	$50,498.20

HC ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT

Facility

$15,141.00

Service Code	HCPCS 43264
Hospital Charge Code	3614326401
Hospital Revenue Code	361
Min. Negotiated Rate	$12,869.85
Max. Negotiated Rate	$14,686.77
Rate for Payer: Cash Price	$9,084.60
Rate for Payer: Health Management Network Commercial	$12,869.85
Rate for Payer: MDX Hawaii PPO	$14,686.77

HC ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT

Facility

$15,141.00

Service Code	HCPCS 43264
Hospital Charge Code	3614326401
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$14,686.77
Rate for Payer: AlohaCare Medicaid	$4,554.64
Rate for Payer: AlohaCare Medicare	$4,554.64
Rate for Payer: Cash Price	$9,084.60
Rate for Payer: Cash Price	$9,084.60
Rate for Payer: Cash Price	$9,084.60
Rate for Payer: Devoted Health Medicare	$5,010.10
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$13,778.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,554.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Health Management Network Commercial	$12,869.85
Rate for Payer: Humana Medicare	$4,554.64
Rate for Payer: Kaiser Permanente Commercial	$9,538.83
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,554.64
Rate for Payer: MDX Hawaii PPO	$14,686.77
Rate for Payer: Ohana Health Plan Medicaid	$5,010.10
Rate for Payer: Ohana Health Plan Medicare	$4,554.64
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,554.64
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT

Facility

$23,196.00

Service Code	HCPCS 43274
Hospital Charge Code	3614327401
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$22,500.12
Rate for Payer: AlohaCare Medicaid	$7,171.82
Rate for Payer: AlohaCare Medicare	$7,171.82
Rate for Payer: Cash Price	$13,917.60
Rate for Payer: Cash Price	$13,917.60
Rate for Payer: Cash Price	$13,917.60
Rate for Payer: Devoted Health Medicare	$7,889.00
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$13,778.00
Rate for Payer: Hawaii Medical Service Association Medicare	$7,171.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,294.85
Rate for Payer: Health Management Network Commercial	$19,716.60
Rate for Payer: Humana Medicare	$7,171.82
Rate for Payer: Kaiser Permanente Commercial	$14,613.48
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,171.82
Rate for Payer: MDX Hawaii PPO	$22,500.12
Rate for Payer: Ohana Health Plan Medicaid	$7,889.00
Rate for Payer: Ohana Health Plan Medicare	$7,171.82
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$7,171.82
Rate for Payer: University Health Alliance Commercial	$10,679.55

HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT

Facility

$23,196.00

Service Code	HCPCS 43274
Hospital Charge Code	3614327401
Hospital Revenue Code	361
Min. Negotiated Rate	$19,716.60
Max. Negotiated Rate	$22,500.12
Rate for Payer: Cash Price	$13,917.60
Rate for Payer: Health Management Network Commercial	$19,716.60
Rate for Payer: MDX Hawaii PPO	$22,500.12

HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY

Facility

$13,274.00

Service Code	HCPCS 43262
Hospital Charge Code	3614623201
Hospital Revenue Code	361
Min. Negotiated Rate	$11,282.90
Max. Negotiated Rate	$12,875.78
Rate for Payer: Cash Price	$7,964.40
Rate for Payer: Health Management Network Commercial	$11,282.90
Rate for Payer: MDX Hawaii PPO	$12,875.78

HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY

Facility

$13,274.00

Service Code	HCPCS 43262
Hospital Charge Code	3614623201
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$12,875.78
Rate for Payer: AlohaCare Medicaid	$4,554.64
Rate for Payer: AlohaCare Medicare	$4,554.64
Rate for Payer: Cash Price	$7,964.40
Rate for Payer: Cash Price	$7,964.40
Rate for Payer: Cash Price	$7,964.40
Rate for Payer: Devoted Health Medicare	$5,010.10
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	$4,554.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Health Management Network Commercial	$11,282.90
Rate for Payer: Humana Medicare	$4,554.64
Rate for Payer: Kaiser Permanente Commercial	$8,362.62
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,554.64
Rate for Payer: MDX Hawaii PPO	$12,875.78
Rate for Payer: Ohana Health Plan Medicaid	$5,010.10
Rate for Payer: Ohana Health Plan Medicare	$4,554.64
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,554.64
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC ESCHAROTOMY

Facility

$1,590.00

Service Code	HCPCS 16035
Hospital Charge Code	7611603501
Hospital Revenue Code	450
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$1,542.30
Rate for Payer: Cash Price	$954.00
Rate for Payer: Health Management Network Commercial	$1,351.50
Rate for Payer: MDX Hawaii PPO	$1,542.30

HC ESCHAROTOMY

Facility

$1,590.00

Service Code	HCPCS 16035
Hospital Charge Code	7611603501
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,536.00
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Cash Price	$954.00
Rate for Payer: Devoted Health Medicare	$528.25
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	$480.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Hawaii Western Management Group Commercial	$1,510.50
Rate for Payer: Health Management Network Commercial	$1,351.50
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Commercial	$1,001.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: MDX Hawaii PPO	$1,542.30
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicare	$480.23
Rate for Payer: University Health Alliance Commercial	$1,158.95

HC ESCHAROTOMY; EACH ADDITIONAL INCISION

Facility

$403.00

Service Code	HCPCS 16036
Hospital Charge Code	4501603601
Hospital Revenue Code	450
Min. Negotiated Rate	$253.89
Max. Negotiated Rate	$1,600.00
Rate for Payer: Cash Price	$241.80
Rate for Payer: Cash Price	$241.80
Rate for Payer: Cash Price	$241.80
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$382.85
Rate for Payer: Health Management Network Commercial	$342.55
Rate for Payer: Kaiser Permanente Commercial	$253.89
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$390.91
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$293.75

HC ESCHAROTOMY; EACH ADDITIONAL INCISION

Facility

$403.00

Service Code	HCPCS 16036
Hospital Charge Code	4501603601
Hospital Revenue Code	450
Min. Negotiated Rate	$342.55
Max. Negotiated Rate	$390.91
Rate for Payer: Cash Price	$241.80
Rate for Payer: Health Management Network Commercial	$342.55
Rate for Payer: MDX Hawaii PPO	$390.91

HC ESOPHAGEAL MOTILITY STUDY, IMAGING - NM ESOPHAGUS MOTILITY

Facility

$1,999.00

Service Code	HCPCS 78258
Hospital Charge Code	3417825801
Hospital Revenue Code	341
Min. Negotiated Rate	$1,699.15
Max. Negotiated Rate	$1,939.03
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: MDX Hawaii PPO	$1,939.03

HC ESOPHAGEAL MOTILITY STUDY, IMAGING - NM ESOPHAGUS MOTILITY

Facility

$1,999.00

Service Code	HCPCS 78258
Hospital Charge Code	3417825801
Hospital Revenue Code	341
Min. Negotiated Rate	$94.70
Max. Negotiated Rate	$1,939.03
Rate for Payer: AlohaCare Medicaid	$472.27
Rate for Payer: AlohaCare Medicare	$472.27
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Cash Price	$1,199.40
Rate for Payer: Devoted Health Medicare	$519.50
Rate for Payer: Hawaii Medical Service Association ABD	$94.70
Rate for Payer: Hawaii Medical Service Association Commercial	$590.34
Rate for Payer: Hawaii Medical Service Association Medicare	$472.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$103.03
Rate for Payer: Hawaii Western Management Group Commercial	$472.27
Rate for Payer: Health Management Network Commercial	$1,699.15
Rate for Payer: Humana Medicare	$472.27
Rate for Payer: Kaiser Permanente Commercial	$1,259.37
Rate for Payer: Kaiser Permanente Medicaid	$1,019.49
Rate for Payer: Kaiser Permanente Medicare	$472.27
Rate for Payer: MDX Hawaii PPO	$1,939.03
Rate for Payer: Ohana Health Plan Medicaid	$519.50
Rate for Payer: Ohana Health Plan Medicare	$472.27
Rate for Payer: UnitedHealthcare Medicaid	$94.70
Rate for Payer: UnitedHealthcare Medicare	$472.27
Rate for Payer: University Health Alliance Commercial	$401.43

HC ESOPHAGOGASTRIC TAMPONADE,BALLOON - MINNESOTA TUBE INSERTION

Facility

$3,653.00

Service Code	HCPCS 43460
Hospital Charge Code	7504346001
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$3,543.41
Rate for Payer: Cash Price	$2,191.80
Rate for Payer: Cash Price	$2,191.80
Rate for Payer: Cash Price	$2,191.80
Rate for Payer: Hawaii Medical Service Association ABD	$569.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,470.35
Rate for Payer: Health Management Network Commercial	$3,105.05
Rate for Payer: Kaiser Permanente Commercial	$2,301.39
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: MDX Hawaii PPO	$3,543.41
Rate for Payer: University Health Alliance Commercial	$2,662.67

HC ESOPHAGOGASTRIC TAMPONADE,BALLOON - MINNESOTA TUBE INSERTION

Facility

$3,653.00

Service Code	HCPCS 43460
Hospital Charge Code	7504346001
Hospital Revenue Code	450
Min. Negotiated Rate	$3,105.05
Max. Negotiated Rate	$3,543.41
Rate for Payer: Cash Price	$2,191.80
Rate for Payer: Health Management Network Commercial	$3,105.05
Rate for Payer: MDX Hawaii PPO	$3,543.41

HC ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC - EGD

Facility

$3,731.00

Service Code	HCPCS 43235
Hospital Charge Code	3604323502
Hospital Revenue Code	360
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$3,619.07
Rate for Payer: AlohaCare Medicaid	$1,071.46
Rate for Payer: AlohaCare Medicare	$1,071.46
Rate for Payer: Cash Price	$2,238.60
Rate for Payer: Cash Price	$2,238.60
Rate for Payer: Cash Price	$2,238.60
Rate for Payer: Devoted Health Medicare	$1,178.61
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	$1,071.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Health Management Network Commercial	$3,171.35
Rate for Payer: Humana Medicare	$1,071.46
Rate for Payer: Kaiser Permanente Commercial	$2,350.53
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,071.46
Rate for Payer: MDX Hawaii PPO	$3,619.07
Rate for Payer: Ohana Health Plan Medicaid	$1,178.61
Rate for Payer: Ohana Health Plan Medicare	$1,071.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,071.46
Rate for Payer: University Health Alliance Commercial	$2,719.53

HC ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC - EGD

Facility

$3,731.00

Service Code	HCPCS 43235
Hospital Charge Code	3604323502
Hospital Revenue Code	360
Min. Negotiated Rate	$3,171.35
Max. Negotiated Rate	$3,619.07
Rate for Payer: Cash Price	$2,238.60
Rate for Payer: Health Management Network Commercial	$3,171.35
Rate for Payer: MDX Hawaii PPO	$3,619.07

HC ESOPHAGRAM - FL ESOPHAGUS BARIUM SWALLOW

Facility

$885.00

Service Code	HCPCS 74220
Hospital Charge Code	3207422001
Hospital Revenue Code	320
Min. Negotiated Rate	$752.25
Max. Negotiated Rate	$858.45
Rate for Payer: Cash Price	$531.00
Rate for Payer: Health Management Network Commercial	$752.25
Rate for Payer: MDX Hawaii PPO	$858.45

HC ESOPHAGRAM - FL ESOPHAGUS BARIUM SWALLOW

Facility

$885.00

Service Code	HCPCS 74220
Hospital Charge Code	3207422001
Hospital Revenue Code	320
Min. Negotiated Rate	$39.30
Max. Negotiated Rate	$858.45
Rate for Payer: AlohaCare Medicaid	$207.21
Rate for Payer: AlohaCare Medicare	$207.21
Rate for Payer: Cash Price	$531.00
Rate for Payer: Cash Price	$531.00
Rate for Payer: Devoted Health Medicare	$227.93
Rate for Payer: Hawaii Medical Service Association ABD	$39.30
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$207.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42.37
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$752.25
Rate for Payer: Humana Medicare	$207.21
Rate for Payer: Kaiser Permanente Commercial	$557.55
Rate for Payer: Kaiser Permanente Medicaid	$451.35
Rate for Payer: Kaiser Permanente Medicare	$207.21
Rate for Payer: MDX Hawaii PPO	$858.45
Rate for Payer: Ohana Health Plan Medicaid	$227.93
Rate for Payer: Ohana Health Plan Medicare	$207.21
Rate for Payer: UnitedHealthcare Medicaid	$39.30
Rate for Payer: UnitedHealthcare Medicare	$207.21
Rate for Payer: University Health Alliance Commercial	$167.61

HC EVAL OF BRONCHOSPASM,PROLONGED - BRONCHIAL CHALLENGE W METHACHOLINE

Facility

$1,239.00

Service Code	HCPCS 94070
Hospital Charge Code	4609407001
Hospital Revenue Code	460
Min. Negotiated Rate	$30.15
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	$30.15
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	$48.37
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	$30.15
Rate for Payer: UnitedHealthcare Medicare	$440.83
Rate for Payer: University Health Alliance Commercial	$903.11

HC EVAL OF BRONCHOSPASM,PROLONGED - BRONCHIAL CHALLENGE W METHACHOLINE

Facility

$1,239.00

Service Code	HCPCS 94070
Hospital Charge Code	4609407001
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 EVOKED AUDITORY TEST,LIMITED

Facility

$1,239.00

Service Code	HCPCS 92587
Hospital Charge Code	4719258701
Hospital Revenue Code	471
Min. Negotiated Rate	$43.74
Max. Negotiated Rate	$1,201.83
Rate for Payer: AlohaCare Medicaid	$255.08
Rate for Payer: AlohaCare Medicare	$255.08
Rate for Payer: Cash Price	$743.40
Rate for Payer: Cash Price	$743.40
Rate for Payer: Devoted Health Medicare	$280.59
Rate for Payer: Hawaii Medical Service Association ABD	$43.74
Rate for Payer: Hawaii Medical Service Association Commercial	$318.85
Rate for Payer: Hawaii Medical Service Association Medicare	$255.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$47.25
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	$255.08
Rate for Payer: Kaiser Permanente Commercial	$780.57
Rate for Payer: Kaiser Permanente Medicaid	$631.89
Rate for Payer: Kaiser Permanente Medicare	$255.08
Rate for Payer: MDX Hawaii PPO	$1,201.83
Rate for Payer: Ohana Health Plan Medicaid	$280.59
Rate for Payer: Ohana Health Plan Medicare	$255.08
Rate for Payer: UnitedHealthcare Medicaid	$43.74
Rate for Payer: UnitedHealthcare Medicare	$255.08
Rate for Payer: University Health Alliance Commercial	$903.11

HC EVOKED AUDITORY TEST,LIMITED

Facility

$1,239.00

Service Code	HCPCS 92587
Hospital Charge Code	4719258701
Hospital Revenue Code	471
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 EXAM,SYNOVIAL FLUID CRYSTALS - SYNOVIAL FLUID CRYSTAL

Facility

$61.00

Service Code	HCPCS 89060
Hospital Charge Code	3008906001
Hospital Revenue Code	300
Min. Negotiated Rate	$51.85
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$36.60
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: MDX Hawaii PPO	$59.17

Know your out-of-pocket cost for care.

All Charges