Kona Community Hospital

All Charges

Charge

Type

Setting

Price

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE

Facility

$6,183.00

Service Code	CPT 43236
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$1,071.46
Rate for Payer: AlohaCare Medicare	$1,071.46
Rate for Payer: Devoted Health Medicare	$1,178.61
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,071.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$1,071.46
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,071.46
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	$5,160.40

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH ENDOSCOPIC MUCOSAL RESECTION

Facility

$6,183.00

Service Code	CPT 43254
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$2,266.89
Rate for Payer: AlohaCare Medicare	$2,266.89
Rate for Payer: Devoted Health Medicare	$2,493.58
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,266.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$2,266.89
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,266.89
Rate for Payer: Ohana Health Plan Medicaid	$2,493.58
Rate for Payer: Ohana Health Plan Medicare	$2,266.89
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,266.89
Rate for Payer: University Health Alliance Commercial	$5,160.40

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH ESOPHAGOGASTRIC FUNDOPLASTY, PARTIAL OR COMPLETE, INCLUDES DUODENOSCOPY WHEN PERFORMED

Facility

$15,696.88

Service Code	CPT 43210
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$15,696.88
Rate for Payer: AlohaCare Medicaid	$12,557.50
Rate for Payer: AlohaCare Medicare	$12,557.50
Rate for Payer: Devoted Health Medicare	$13,813.25
Rate for Payer: Hawaii Medical Service Association Commercial	$15,696.88
Rate for Payer: Hawaii Medical Service Association Medicare	$12,557.50
Rate for Payer: Humana Medicare	$12,557.50
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$12,557.50
Rate for Payer: Ohana Health Plan Medicaid	$13,813.25
Rate for Payer: Ohana Health Plan Medicare	$12,557.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$12,557.50

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH INSERTION OF GUIDE WIRE FOLLOWED BY PASSAGE OF DILATOR(S) THROUGH ESOPHAGUS OVER GUIDE WIRE

Facility

$6,183.00

Service Code	CPT 43248
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$1,071.46
Rate for Payer: AlohaCare Medicare	$1,071.46
Rate for Payer: Devoted Health Medicare	$1,178.61
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,071.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$1,071.46
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,071.46
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	$5,160.40

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF FOREIGN BODY(S)

Facility

$6,183.00

Service Code	CPT 43247
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$1,071.46
Rate for Payer: AlohaCare Medicare	$1,071.46
Rate for Payer: Devoted Health Medicare	$1,178.61
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,071.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$1,071.46
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,071.46
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	$5,160.40

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS

Facility

$6,183.00

Service Code	CPT 43250
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$2,266.89
Rate for Payer: AlohaCare Medicare	$2,266.89
Rate for Payer: Devoted Health Medicare	$2,493.58
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,266.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$2,266.89
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,266.89
Rate for Payer: Ohana Health Plan Medicaid	$2,493.58
Rate for Payer: Ohana Health Plan Medicare	$2,266.89
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,266.89
Rate for Payer: University Health Alliance Commercial	$5,160.40

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE

Facility

$6,183.00

Service Code	CPT 43251
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$2,266.89
Rate for Payer: AlohaCare Medicare	$2,266.89
Rate for Payer: Devoted Health Medicare	$2,493.58
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,266.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$2,266.89
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,266.89
Rate for Payer: Ohana Health Plan Medicaid	$2,493.58
Rate for Payer: Ohana Health Plan Medicare	$2,266.89
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,266.89
Rate for Payer: University Health Alliance Commercial	$5,160.40

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION OF ESOPHAGUS (LESS THAN 30 MM DIAMETER)

Facility

$6,183.00

Service Code	CPT 43249
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$2,266.89
Rate for Payer: AlohaCare Medicare	$2,266.89
Rate for Payer: Devoted Health Medicare	$2,493.58
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,266.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$2,266.89
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,266.89
Rate for Payer: Ohana Health Plan Medicaid	$2,493.58
Rate for Payer: Ohana Health Plan Medicare	$2,266.89
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,266.89
Rate for Payer: University Health Alliance Commercial	$5,160.40

ESOPHAGOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$2,837.00

Service Code	CPT 43202
Hospital Revenue Code	360
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$2,266.89
Rate for Payer: AlohaCare Medicare	$2,266.89
Rate for Payer: Devoted Health Medicare	$2,493.58
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,266.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Humana Medicare	$2,266.89
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,266.89
Rate for Payer: Ohana Health Plan Medicaid	$2,493.58
Rate for Payer: Ohana Health Plan Medicare	$2,266.89
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,266.89

ESTRADIOL 0.5 MG PO TABLET

Facility

$3.05

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$2.96
Rate for Payer: Cash Price	$1.98
Rate for Payer: Hawaii Western Management Group Commercial	$2.90
Rate for Payer: Health Management Network Commercial	$2.59
Rate for Payer: Kaiser Permanente Commercial	$1.92
Rate for Payer: Kaiser Permanente Medicaid	$1.56
Rate for Payer: MDX Hawaii PPO	$2.96
Rate for Payer: UnitedHealthcare Medicaid	$1.83
Rate for Payer: University Health Alliance Commercial	$2.22

ESTRADIOL 0.5 MG PO TABLET

Facility

$3.05

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$2.96
Rate for Payer: Cash Price	$1.98
Rate for Payer: Health Management Network Commercial	$2.59
Rate for Payer: MDX Hawaii PPO	$2.96

ETHAMBUTOL 400 MG PO TABLET

Facility

$9.86

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.38
Max. Negotiated Rate	$9.56
Rate for Payer: Cash Price	$6.41
Rate for Payer: Health Management Network Commercial	$8.38
Rate for Payer: MDX Hawaii PPO	$9.56

ETHAMBUTOL 400 MG PO TABLET

Facility

$9.86

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$9.56
Rate for Payer: Cash Price	$6.41
Rate for Payer: Hawaii Western Management Group Commercial	$9.37
Rate for Payer: Health Management Network Commercial	$8.38
Rate for Payer: Kaiser Permanente Commercial	$6.21
Rate for Payer: Kaiser Permanente Medicaid	$5.03
Rate for Payer: MDX Hawaii PPO	$9.56
Rate for Payer: UnitedHealthcare Medicaid	$5.92
Rate for Payer: University Health Alliance Commercial	$7.19

ETHYL CHLORIDE 100 % TOP AERO.SPRAY

Facility

$158.98

Service Code	NDC 00386000103
Hospital Revenue Code	250
Min. Negotiated Rate	$81.08
Max. Negotiated Rate	$154.21
Rate for Payer: Cash Price	$103.34
Rate for Payer: Hawaii Western Management Group Commercial	$151.03
Rate for Payer: Health Management Network Commercial	$135.13
Rate for Payer: Kaiser Permanente Commercial	$100.16
Rate for Payer: Kaiser Permanente Medicaid	$81.08
Rate for Payer: MDX Hawaii PPO	$154.21
Rate for Payer: UnitedHealthcare Medicaid	$95.39
Rate for Payer: University Health Alliance Commercial	$115.88

ETHYL CHLORIDE 100 % TOP AERO.SPRAY

Facility

$158.98

Service Code	NDC 00386000103
Hospital Revenue Code	250
Min. Negotiated Rate	$135.13
Max. Negotiated Rate	$154.21
Rate for Payer: Cash Price	$103.34
Rate for Payer: Health Management Network Commercial	$135.13
Rate for Payer: MDX Hawaii PPO	$154.21

ETOMIDATE 2 MG/ML IV SOLN

Facility

$24.51

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$23.77
Rate for Payer: Cash Price	$15.93
Rate for Payer: Cash Price	$14.35
Rate for Payer: Cash Price	$36.42
Rate for Payer: Hawaii Western Management Group Commercial	$53.23
Rate for Payer: Hawaii Western Management Group Commercial	$23.28
Rate for Payer: Hawaii Western Management Group Commercial	$20.98
Rate for Payer: Health Management Network Commercial	$18.77
Rate for Payer: Health Management Network Commercial	$20.83
Rate for Payer: Health Management Network Commercial	$47.63
Rate for Payer: Kaiser Permanente Commercial	$13.91
Rate for Payer: Kaiser Permanente Commercial	$15.44
Rate for Payer: Kaiser Permanente Commercial	$35.30
Rate for Payer: Kaiser Permanente Medicaid	$11.26
Rate for Payer: Kaiser Permanente Medicaid	$12.50
Rate for Payer: Kaiser Permanente Medicaid	$28.58
Rate for Payer: MDX Hawaii PPO	$21.42
Rate for Payer: MDX Hawaii PPO	$23.77
Rate for Payer: MDX Hawaii PPO	$54.35
Rate for Payer: UnitedHealthcare Medicaid	$14.71
Rate for Payer: UnitedHealthcare Medicaid	$33.62
Rate for Payer: UnitedHealthcare Medicaid	$13.25
Rate for Payer: University Health Alliance Commercial	$40.84
Rate for Payer: University Health Alliance Commercial	$16.09
Rate for Payer: University Health Alliance Commercial	$17.87

ETOMIDATE 2 MG/ML IV SOLN

Facility

$24.51

Service Code	HCPCS J3490
Hospital Revenue Code	250
Min. Negotiated Rate	$20.83
Max. Negotiated Rate	$23.77
Rate for Payer: Cash Price	$15.93
Rate for Payer: Cash Price	$14.35
Rate for Payer: Cash Price	$36.42
Rate for Payer: Health Management Network Commercial	$20.83
Rate for Payer: Health Management Network Commercial	$18.77
Rate for Payer: Health Management Network Commercial	$47.63
Rate for Payer: MDX Hawaii PPO	$21.42
Rate for Payer: MDX Hawaii PPO	$54.35
Rate for Payer: MDX Hawaii PPO	$23.77

ETONOGESTREL 68 MG SDRM IMPLANT

Facility

$2,575.96

Service Code	HCPCS J7307
Hospital Revenue Code	250
Min. Negotiated Rate	$2,189.57
Max. Negotiated Rate	$2,498.68
Rate for Payer: Cash Price	$1,674.37
Rate for Payer: Health Management Network Commercial	$2,189.57
Rate for Payer: MDX Hawaii PPO	$2,498.68

ETONOGESTREL 68 MG SDRM IMPLANT

Facility

$2,575.96

Service Code	HCPCS J7307
Hospital Revenue Code	636
Min. Negotiated Rate	$1,214.63
Max. Negotiated Rate	$2,498.68
Rate for Payer: Cash Price	$1,674.37
Rate for Payer: Cash Price	$1,674.37
Rate for Payer: Hawaii Medical Service Association ABD	$1,214.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,214.63
Rate for Payer: Hawaii Western Management Group Commercial	$2,447.16
Rate for Payer: Health Management Network Commercial	$2,189.57
Rate for Payer: Kaiser Permanente Commercial	$1,622.85
Rate for Payer: Kaiser Permanente Medicaid	$1,313.74
Rate for Payer: MDX Hawaii PPO	$2,498.68
Rate for Payer: UnitedHealthcare Medicaid	$1,545.58
Rate for Payer: University Health Alliance Commercial	$1,877.62

ETOPOSIDE 20 MG/ML IV SOLN

Facility

$65.08

Service Code	HCPCS J9181
Hospital Revenue Code	636
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$63.13
Rate for Payer: Cash Price	$42.30
Rate for Payer: Cash Price	$42.30
Rate for Payer: Hawaii Medical Service Association ABD	$1.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.30
Rate for Payer: Hawaii Western Management Group Commercial	$61.83
Rate for Payer: Health Management Network Commercial	$55.32
Rate for Payer: Kaiser Permanente Commercial	$41.00
Rate for Payer: Kaiser Permanente Medicaid	$33.19
Rate for Payer: MDX Hawaii PPO	$63.13
Rate for Payer: UnitedHealthcare Medicaid	$39.05
Rate for Payer: University Health Alliance Commercial	$47.44

ETOPOSIDE 20 MG/ML IV SOLN

Facility

$65.08

Service Code	HCPCS J9181
Hospital Revenue Code	250
Min. Negotiated Rate	$55.32
Max. Negotiated Rate	$63.13
Rate for Payer: Cash Price	$42.30
Rate for Payer: Health Management Network Commercial	$55.32
Rate for Payer: MDX Hawaii PPO	$63.13

EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 1.1 TO 2.0 CM

Facility

$4,035.20

Service Code	CPT 11422
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association Commercial	$2,438.89
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
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	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,035.20

EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 2.1 TO 3.0 CM

Facility

$5,160.40

Service Code	CPT 11423
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association Commercial	$2,438.89
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
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

EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER OVER 4.0 CM

Facility

$6,183.00

Service Code	CPT 11426
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Devoted Health Medicare	$3,774.62
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,431.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: Ohana Health Plan Medicaid	$3,774.62
Rate for Payer: Ohana Health Plan Medicare	$3,431.47
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,431.47
Rate for Payer: University Health Alliance Commercial	$5,160.40

EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 1.1 TO 2.0 CM

Facility

$4,035.20

Service Code	CPT 11402
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$836.55
Rate for Payer: AlohaCare Medicare	$836.55
Rate for Payer: Devoted Health Medicare	$920.21
Rate for Payer: Hawaii Medical Service Association Commercial	$1,045.69
Rate for Payer: Hawaii Medical Service Association Medicare	$836.55
Rate for Payer: Humana Medicare	$836.55
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$836.55
Rate for Payer: Ohana Health Plan Medicaid	$920.21
Rate for Payer: Ohana Health Plan Medicare	$836.55
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$836.55
Rate for Payer: University Health Alliance Commercial	$4,035.20

Know your out-of-pocket cost for care.

All Charges