Kau Hospital

All Charges

Charge

Type

Setting

Price

HC PBB REFOREARM TEND/MUSC,EXTEN,PRIM,EA

Facility

$12,643.00

Service Code	HCPCS 25270
Hospital Charge Code	76125270PB
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$12,263.71
Rate for Payer: AlohaCare Medicaid	$6,321.50
Rate for Payer: AlohaCare Medicare	$3,919.33
Rate for Payer: Cash Price	$7,585.80
Rate for Payer: Cash Price	$7,585.80
Rate for Payer: Cash Price	$7,585.80
Rate for Payer: Devoted Health Medicare	$4,298.62
Rate for Payer: Hawaii Medical Service Association Commercial	$4,178.59
Rate for Payer: Hawaii Medical Service Association Medicare	$3,919.33
Rate for Payer: Hawaii Western Management Group Commercial	$12,010.85
Rate for Payer: Health Management Network Commercial	$10,746.55
Rate for Payer: Humana Medicare	$3,919.33
Rate for Payer: Kaiser Permanente Commercial	$11,378.70
Rate for Payer: Kaiser Permanente Medicaid	$6,447.93
Rate for Payer: Kaiser Permanente Medicare	$3,919.33
Rate for Payer: MDX Hawaii PPO	$12,263.71
Rate for Payer: Ohana Health Plan Medicaid	$3,919.33
Rate for Payer: Ohana Health Plan Medicare	$3,919.33
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,919.33
Rate for Payer: University Health Alliance Commercial	$10,679.55

HC PBB REFOREARM TEND/MUSC,EXTEN,PRIM,EA

Facility

$12,643.00

Service Code	HCPCS 25270
Hospital Charge Code	76125270PB
Hospital Revenue Code	761
Min. Negotiated Rate	$10,746.55
Max. Negotiated Rate	$12,263.71
Rate for Payer: Cash Price	$7,585.80
Rate for Payer: Health Management Network Commercial	$10,746.55
Rate for Payer: Kaiser Permanente Commercial	$11,378.70
Rate for Payer: MDX Hawaii PPO	$12,263.71

HC PBB REFOREARM TEND/MUSC,FLEX,PRIM,EA

Facility

$12,912.00

Service Code	HCPCS 25260
Hospital Charge Code	76125260PB
Hospital Revenue Code	761
Min. Negotiated Rate	$10,975.20
Max. Negotiated Rate	$12,524.64
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Health Management Network Commercial	$10,975.20
Rate for Payer: Kaiser Permanente Commercial	$11,620.80
Rate for Payer: MDX Hawaii PPO	$12,524.64

HC PBB REFOREARM TEND/MUSC,FLEX,PRIM,EA

Facility

$12,912.00

Service Code	HCPCS 25260
Hospital Charge Code	76125260PB
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$12,524.64
Rate for Payer: AlohaCare Medicaid	$6,456.00
Rate for Payer: AlohaCare Medicare	$4,002.72
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Devoted Health Medicare	$4,390.08
Rate for Payer: Hawaii Medical Service Association Commercial	$4,178.59
Rate for Payer: Hawaii Medical Service Association Medicare	$4,002.72
Rate for Payer: Hawaii Western Management Group Commercial	$12,266.40
Rate for Payer: Health Management Network Commercial	$10,975.20
Rate for Payer: Humana Medicare	$4,002.72
Rate for Payer: Kaiser Permanente Commercial	$11,620.80
Rate for Payer: Kaiser Permanente Medicaid	$6,585.12
Rate for Payer: Kaiser Permanente Medicare	$4,002.72
Rate for Payer: MDX Hawaii PPO	$12,524.64
Rate for Payer: Ohana Health Plan Medicaid	$4,002.72
Rate for Payer: Ohana Health Plan Medicare	$4,002.72
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,002.72
Rate for Payer: University Health Alliance Commercial	$10,679.55

HC PBB REMOVE FOREARM/WRIST FOREIGN BODY

Facility

$6,369.00

Service Code	HCPCS 25248
Hospital Charge Code	76125248PB
Hospital Revenue Code	761
Min. Negotiated Rate	$5,413.65
Max. Negotiated Rate	$6,177.93
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Health Management Network Commercial	$5,413.65
Rate for Payer: Kaiser Permanente Commercial	$5,732.10
Rate for Payer: MDX Hawaii PPO	$6,177.93

HC PBB REMOVE FOREARM/WRIST FOREIGN BODY

Facility

$6,369.00

Service Code	HCPCS 25248
Hospital Charge Code	76125248PB
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,177.93
Rate for Payer: AlohaCare Medicaid	$3,184.50
Rate for Payer: AlohaCare Medicare	$1,974.39
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Devoted Health Medicare	$2,165.46
Rate for Payer: Hawaii Medical Service Association Commercial	$2,053.53
Rate for Payer: Hawaii Medical Service Association Medicare	$1,974.39
Rate for Payer: Hawaii Western Management Group Commercial	$6,050.55
Rate for Payer: Health Management Network Commercial	$5,413.65
Rate for Payer: Humana Medicare	$1,974.39
Rate for Payer: Kaiser Permanente Commercial	$5,732.10
Rate for Payer: Kaiser Permanente Medicaid	$3,248.19
Rate for Payer: Kaiser Permanente Medicare	$1,974.39
Rate for Payer: MDX Hawaii PPO	$6,177.93
Rate for Payer: Ohana Health Plan Medicaid	$1,974.39
Rate for Payer: Ohana Health Plan Medicare	$1,974.39
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,974.39
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC PBB REMV FOOT FOREIGN BODY,COMPLEX

Facility

$6,448.00

Service Code	HCPCS 28193
Hospital Charge Code	76128193PB
Hospital Revenue Code	761
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: Kaiser Permanente Commercial	$5,803.20
Rate for Payer: MDX Hawaii PPO	$6,254.56

HC PBB REMV FOOT FOREIGN BODY,COMPLEX

Facility

$6,448.00

Service Code	HCPCS 28193
Hospital Charge Code	76128193PB
Hospital Revenue Code	761
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$6,254.56
Rate for Payer: AlohaCare Medicaid	$3,224.00
Rate for Payer: AlohaCare Medicare	$1,998.88
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	$2,192.32
Rate for Payer: Hawaii Medical Service Association Commercial	$2,109.21
Rate for Payer: Hawaii Medical Service Association Medicare	$1,998.88
Rate for Payer: Hawaii Western Management Group Commercial	$6,125.60
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: Humana Medicare	$1,998.88
Rate for Payer: Kaiser Permanente Commercial	$5,803.20
Rate for Payer: Kaiser Permanente Medicaid	$3,288.48
Rate for Payer: Kaiser Permanente Medicare	$1,998.88
Rate for Payer: MDX Hawaii PPO	$6,254.56
Rate for Payer: Ohana Health Plan Medicaid	$1,998.88
Rate for Payer: Ohana Health Plan Medicare	$1,998.88
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,998.88
Rate for Payer: University Health Alliance Commercial	$4,699.95

HC PBB REMV FOOT FOREIGN BODY,DEEP

Facility

$6,448.00

Service Code	HCPCS 28192
Hospital Charge Code	76128192PB
Hospital Revenue Code	761
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: Kaiser Permanente Commercial	$5,803.20
Rate for Payer: MDX Hawaii PPO	$6,254.56

HC PBB REMV FOOT FOREIGN BODY,DEEP

Facility

$6,448.00

Service Code	HCPCS 28192
Hospital Charge Code	76128192PB
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,254.56
Rate for Payer: AlohaCare Medicaid	$3,224.00
Rate for Payer: AlohaCare Medicare	$1,998.88
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	$2,192.32
Rate for Payer: Hawaii Medical Service Association Commercial	$2,109.21
Rate for Payer: Hawaii Medical Service Association Medicare	$1,998.88
Rate for Payer: Hawaii Western Management Group Commercial	$6,125.60
Rate for Payer: Health Management Network Commercial	$5,480.80
Rate for Payer: Humana Medicare	$1,998.88
Rate for Payer: Kaiser Permanente Commercial	$5,803.20
Rate for Payer: Kaiser Permanente Medicaid	$3,288.48
Rate for Payer: Kaiser Permanente Medicare	$1,998.88
Rate for Payer: MDX Hawaii PPO	$6,254.56
Rate for Payer: Ohana Health Plan Medicaid	$1,998.88
Rate for Payer: Ohana Health Plan Medicare	$1,998.88
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,998.88
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC PBB REPAIR EXTEN TENDON,DORSUM FINGR,EA

Facility

$6,369.00

Service Code	HCPCS 26418
Hospital Charge Code	76126418PB
Hospital Revenue Code	761
Min. Negotiated Rate	$5,413.65
Max. Negotiated Rate	$6,177.93
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Health Management Network Commercial	$5,413.65
Rate for Payer: Kaiser Permanente Commercial	$5,732.10
Rate for Payer: MDX Hawaii PPO	$6,177.93

HC PBB REPAIR EXTEN TENDON,DORSUM FINGR,EA

Facility

$6,369.00

Service Code	HCPCS 26418
Hospital Charge Code	76126418PB
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$10,679.55
Rate for Payer: AlohaCare Medicaid	$3,184.50
Rate for Payer: AlohaCare Medicare	$1,974.39
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Devoted Health Medicare	$2,165.46
Rate for Payer: Hawaii Medical Service Association Commercial	$2,053.53
Rate for Payer: Hawaii Medical Service Association Medicare	$1,974.39
Rate for Payer: Hawaii Western Management Group Commercial	$6,050.55
Rate for Payer: Health Management Network Commercial	$5,413.65
Rate for Payer: Humana Medicare	$1,974.39
Rate for Payer: Kaiser Permanente Commercial	$5,732.10
Rate for Payer: Kaiser Permanente Medicaid	$3,248.19
Rate for Payer: Kaiser Permanente Medicare	$1,974.39
Rate for Payer: MDX Hawaii PPO	$6,177.93
Rate for Payer: Ohana Health Plan Medicaid	$1,974.39
Rate for Payer: Ohana Health Plan Medicare	$1,974.39
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,974.39
Rate for Payer: University Health Alliance Commercial	$10,679.55

HC PBB REPAIR PALATE LACER <2 CM

Facility

$1,984.00

Service Code	HCPCS 42180
Hospital Charge Code	76142180PB
Hospital Revenue Code	761
Min. Negotiated Rate	$1,686.40
Max. Negotiated Rate	$1,924.48
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Health Management Network Commercial	$1,686.40
Rate for Payer: Kaiser Permanente Commercial	$1,785.60
Rate for Payer: MDX Hawaii PPO	$1,924.48

HC PBB REPAIR PALATE LACER <2 CM

Facility

$1,984.00

Service Code	HCPCS 42180
Hospital Charge Code	76142180PB
Hospital Revenue Code	761
Min. Negotiated Rate	$137.66
Max. Negotiated Rate	$1,924.48
Rate for Payer: AlohaCare Medicaid	$992.00
Rate for Payer: AlohaCare Medicare	$615.04
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Cash Price	$1,190.40
Rate for Payer: Devoted Health Medicare	$674.56
Rate for Payer: Hawaii Medical Service Association Commercial	$688.76
Rate for Payer: Hawaii Medical Service Association Medicare	$615.04
Rate for Payer: Hawaii Western Management Group Commercial	$1,884.80
Rate for Payer: Health Management Network Commercial	$1,686.40
Rate for Payer: Humana Medicare	$615.04
Rate for Payer: Kaiser Permanente Commercial	$1,785.60
Rate for Payer: Kaiser Permanente Medicaid	$1,011.84
Rate for Payer: Kaiser Permanente Medicare	$615.04
Rate for Payer: MDX Hawaii PPO	$1,924.48
Rate for Payer: Ohana Health Plan Medicaid	$615.04
Rate for Payer: Ohana Health Plan Medicare	$615.04
Rate for Payer: UnitedHealthcare Medicaid	$137.66
Rate for Payer: UnitedHealthcare Medicare	$615.04
Rate for Payer: University Health Alliance Commercial	$1,446.14

HC PHLEBOTOMY

Facility

$667.00

Service Code	HCPCS 99195
Hospital Charge Code	9409919501
Hospital Revenue Code	940
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$646.99
Rate for Payer: AlohaCare Medicaid	$333.50
Rate for Payer: AlohaCare Medicare	$206.77
Rate for Payer: Cash Price	$400.20
Rate for Payer: Cash Price	$400.20
Rate for Payer: Devoted Health Medicare	$226.78
Rate for Payer: Hawaii Medical Service Association Commercial	$169.91
Rate for Payer: Hawaii Medical Service Association Medicare	$206.77
Rate for Payer: Hawaii Western Management Group Commercial	$633.65
Rate for Payer: Health Management Network Commercial	$566.95
Rate for Payer: Humana Medicare	$206.77
Rate for Payer: Kaiser Permanente Commercial	$600.30
Rate for Payer: Kaiser Permanente Medicaid	$340.17
Rate for Payer: Kaiser Permanente Medicare	$206.77
Rate for Payer: MDX Hawaii PPO	$646.99
Rate for Payer: Ohana Health Plan Medicaid	$206.77
Rate for Payer: Ohana Health Plan Medicare	$206.77
Rate for Payer: UnitedHealthcare Medicaid	$14.85
Rate for Payer: UnitedHealthcare Medicare	$206.77
Rate for Payer: University Health Alliance Commercial	$486.18

HC PHLEBOTOMY

Facility

$667.00

Service Code	HCPCS 99195
Hospital Charge Code	9409919501
Hospital Revenue Code	940
Min. Negotiated Rate	$566.95
Max. Negotiated Rate	$646.99
Rate for Payer: Cash Price	$400.20
Rate for Payer: Health Management Network Commercial	$566.95
Rate for Payer: Kaiser Permanente Commercial	$600.30
Rate for Payer: MDX Hawaii PPO	$646.99

HC P-INC DRAIN ABSC HEMATOMA

Facility

$12,912.00

Service Code	HCPCS 26990
Hospital Charge Code	3612699001
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$12,524.64
Rate for Payer: AlohaCare Medicaid	$6,456.00
Rate for Payer: AlohaCare Medicare	$4,002.72
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Devoted Health Medicare	$4,390.08
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	$4,002.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$12,266.40
Rate for Payer: Health Management Network Commercial	$10,975.20
Rate for Payer: Humana Medicare	$4,002.72
Rate for Payer: Kaiser Permanente Commercial	$11,620.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$4,002.72
Rate for Payer: MDX Hawaii PPO	$12,524.64
Rate for Payer: Ohana Health Plan Medicaid	$4,002.72
Rate for Payer: Ohana Health Plan Medicare	$4,002.72
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,002.72
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC P-INC DRAIN ABSC HEMATOMA

Facility

$12,912.00

Service Code	HCPCS 26990
Hospital Charge Code	3612699001
Hospital Revenue Code	450
Min. Negotiated Rate	$10,975.20
Max. Negotiated Rate	$12,524.64
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Health Management Network Commercial	$10,975.20
Rate for Payer: Kaiser Permanente Commercial	$11,620.80
Rate for Payer: MDX Hawaii PPO	$12,524.64

HC PRETREAT SERUM BY DILUT SO

Facility

$243.00

Service Code	HCPCS 86976
Hospital Charge Code	3008697601
Hospital Revenue Code	300
Min. Negotiated Rate	$18.37
Max. Negotiated Rate	$235.71
Rate for Payer: AlohaCare Medicaid	$121.50
Rate for Payer: AlohaCare Medicare	$75.33
Rate for Payer: Cash Price	$145.80
Rate for Payer: Cash Price	$145.80
Rate for Payer: Devoted Health Medicare	$82.62
Rate for Payer: Hawaii Medical Service Association Commercial	$36.94
Rate for Payer: Hawaii Medical Service Association Medicare	$75.33
Rate for Payer: Hawaii Western Management Group Commercial	$29.55
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Humana Medicare	$75.33
Rate for Payer: Kaiser Permanente Commercial	$218.70
Rate for Payer: Kaiser Permanente Medicaid	$123.93
Rate for Payer: Kaiser Permanente Medicare	$75.33
Rate for Payer: MDX Hawaii PPO	$235.71
Rate for Payer: Ohana Health Plan Medicaid	$75.33
Rate for Payer: Ohana Health Plan Medicare	$75.33
Rate for Payer: UnitedHealthcare Medicaid	$18.37
Rate for Payer: UnitedHealthcare Medicare	$75.33
Rate for Payer: University Health Alliance Commercial	$177.12

HC PRETREAT SERUM BY DILUT SO

Facility

$243.00

Service Code	HCPCS 86976
Hospital Charge Code	3008697601
Hospital Revenue Code	300
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$145.80
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Kaiser Permanente Commercial	$218.70
Rate for Payer: MDX Hawaii PPO	$235.71

HC PROCALCITONIN

Facility

$228.00

Service Code	HCPCS 84145
Hospital Charge Code	3018414501
Hospital Revenue Code	301
Min. Negotiated Rate	$27.22
Max. Negotiated Rate	$221.16
Rate for Payer: AlohaCare Medicaid	$114.00
Rate for Payer: AlohaCare Medicare	$70.68
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Devoted Health Medicare	$77.52
Rate for Payer: Hawaii Medical Service Association ABD	$27.76
Rate for Payer: Hawaii Medical Service Association Commercial	$34.02
Rate for Payer: Hawaii Medical Service Association Medicare	$70.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.12
Rate for Payer: Hawaii Western Management Group Commercial	$27.22
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Humana Medicare	$70.68
Rate for Payer: Kaiser Permanente Commercial	$205.20
Rate for Payer: Kaiser Permanente Medicaid	$116.28
Rate for Payer: Kaiser Permanente Medicare	$70.68
Rate for Payer: MDX Hawaii PPO	$221.16
Rate for Payer: Ohana Health Plan Medicaid	$70.68
Rate for Payer: Ohana Health Plan Medicare	$70.68
Rate for Payer: UnitedHealthcare Medicaid	$27.76
Rate for Payer: UnitedHealthcare Medicare	$70.68
Rate for Payer: University Health Alliance Commercial	$51.36

HC PROCALCITONIN

Facility

$228.00

Service Code	HCPCS 84145
Hospital Charge Code	3018414501
Hospital Revenue Code	301
Min. Negotiated Rate	$193.80
Max. Negotiated Rate	$221.16
Rate for Payer: Cash Price	$136.80
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Kaiser Permanente Commercial	$205.20
Rate for Payer: MDX Hawaii PPO	$221.16

HC PROCTOSIGMOIDOSCOPY,REMV F.B. - ENDOSCOPY SIGMOID

Facility

$10,686.00

Service Code	HCPCS 45307
Hospital Charge Code	7504530701
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$10,365.42
Rate for Payer: AlohaCare Medicaid	$5,343.00
Rate for Payer: AlohaCare Medicare	$3,312.66
Rate for Payer: Cash Price	$6,411.60
Rate for Payer: Cash Price	$6,411.60
Rate for Payer: Devoted Health Medicare	$3,633.24
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	$3,312.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$10,151.70
Rate for Payer: Health Management Network Commercial	$9,083.10
Rate for Payer: Humana Medicare	$3,312.66
Rate for Payer: Kaiser Permanente Commercial	$9,617.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,312.66
Rate for Payer: MDX Hawaii PPO	$10,365.42
Rate for Payer: Ohana Health Plan Medicaid	$3,312.66
Rate for Payer: Ohana Health Plan Medicare	$3,312.66
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,312.66
Rate for Payer: University Health Alliance Commercial	$7,789.03

HC PROCTOSIGMOIDOSCOPY,REMV F.B. - ENDOSCOPY SIGMOID

Facility

$10,686.00

Service Code	HCPCS 45307
Hospital Charge Code	7504530701
Hospital Revenue Code	450
Min. Negotiated Rate	$9,083.10
Max. Negotiated Rate	$10,365.42
Rate for Payer: Cash Price	$6,411.60
Rate for Payer: Health Management Network Commercial	$9,083.10
Rate for Payer: Kaiser Permanente Commercial	$9,617.40
Rate for Payer: MDX Hawaii PPO	$10,365.42

HC PROSTATE BIOPSY 10-20

Facility

$3,564.00

Service Code	HCPCS G0416
Hospital Charge Code	314G041601
Hospital Revenue Code	314
Min. Negotiated Rate	$3,029.40
Max. Negotiated Rate	$3,457.08
Rate for Payer: Cash Price	$2,138.40
Rate for Payer: Health Management Network Commercial	$3,029.40
Rate for Payer: Kaiser Permanente Commercial	$3,207.60
Rate for Payer: MDX Hawaii PPO	$3,457.08

Know your out-of-pocket cost for care.

All Charges