Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

HC CLOSED RX NOSE FX W STABILIZATN

Facility

$12,637.00

Service Code	HCPCS 21320
Hospital Charge Code	7612132001
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$12,257.89
Rate for Payer: AlohaCare Medicaid	$6,318.50
Rate for Payer: AlohaCare Medicare	$9,604.12
Rate for Payer: Cash Price	$7,582.20
Rate for Payer: Cash Price	$7,582.20
Rate for Payer: Devoted Health Medicare	$10,615.08
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	$9,604.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$12,005.15
Rate for Payer: Health Management Network Commercial	$10,741.45
Rate for Payer: Humana Medicare	$9,604.12
Rate for Payer: Kaiser Permanente Commercial	$11,373.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$9,604.12
Rate for Payer: MDX Hawaii PPO	$12,257.89
Rate for Payer: Ohana Health Plan Medicaid	$9,604.12
Rate for Payer: Ohana Health Plan Medicare	$9,604.12
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$9,604.12
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC CLOSED RX NOSE FX W STABILIZATN

Facility

$12,637.00

Service Code	HCPCS 21320
Hospital Charge Code	7612132001
Hospital Revenue Code	450
Min. Negotiated Rate	$10,741.45
Max. Negotiated Rate	$12,257.89
Rate for Payer: Cash Price	$7,582.20
Rate for Payer: Health Management Network Commercial	$10,741.45
Rate for Payer: Kaiser Permanente Commercial	$11,373.30
Rate for Payer: MDX Hawaii PPO	$12,257.89

HC CLOSED RX PROX HUMERUS FX,MANIP

Facility

$6,369.00

Service Code	HCPCS 23605
Hospital Charge Code	7612360501
Hospital Revenue Code	450
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 CLOSED RX PROX HUMERUS FX,MANIP

Facility

$6,369.00

Service Code	HCPCS 23605
Hospital Charge Code	7612360501
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$6,177.93
Rate for Payer: AlohaCare Medicaid	$3,184.50
Rate for Payer: AlohaCare Medicare	$4,840.44
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Devoted Health Medicare	$5,349.96
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	$4,840.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
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	$4,840.44
Rate for Payer: Kaiser Permanente Commercial	$5,732.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$4,840.44
Rate for Payer: MDX Hawaii PPO	$6,177.93
Rate for Payer: Ohana Health Plan Medicaid	$4,840.44
Rate for Payer: Ohana Health Plan Medicare	$4,840.44
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,840.44
Rate for Payer: University Health Alliance Commercial	$4,642.36

HC CLOSED RX PROX/NECK FEMUR FX

Facility

$935.00

Service Code	HCPCS 27230
Hospital Charge Code	7612723001
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$467.50
Rate for Payer: AlohaCare Medicare	$710.60
Rate for Payer: Cash Price	$561.00
Rate for Payer: Cash Price	$561.00
Rate for Payer: Devoted Health Medicare	$785.40
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	$710.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$888.25
Rate for Payer: Health Management Network Commercial	$794.75
Rate for Payer: Humana Medicare	$710.60
Rate for Payer: Kaiser Permanente Commercial	$841.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$710.60
Rate for Payer: MDX Hawaii PPO	$906.95
Rate for Payer: Ohana Health Plan Medicaid	$710.60
Rate for Payer: Ohana Health Plan Medicare	$710.60
Rate for Payer: UnitedHealthcare Medicare	$710.60
Rate for Payer: University Health Alliance Commercial	$681.52

HC CLOSED RX PROX/NECK FEMUR FX

Facility

$935.00

Service Code	HCPCS 27230
Hospital Charge Code	7612723001
Hospital Revenue Code	450
Min. Negotiated Rate	$794.75
Max. Negotiated Rate	$906.95
Rate for Payer: Cash Price	$561.00
Rate for Payer: Health Management Network Commercial	$794.75
Rate for Payer: Kaiser Permanente Commercial	$841.50
Rate for Payer: MDX Hawaii PPO	$906.95

HC CLOSED RX RADIAL SHAFT FX

Facility

$955.00

Service Code	HCPCS 25500
Hospital Charge Code	7612550001
Hospital Revenue Code	450
Min. Negotiated Rate	$811.75
Max. Negotiated Rate	$926.35
Rate for Payer: Cash Price	$573.00
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Kaiser Permanente Commercial	$859.50
Rate for Payer: MDX Hawaii PPO	$926.35

HC CLOSED RX RADIAL SHAFT FX

Facility

$955.00

Service Code	HCPCS 25500
Hospital Charge Code	7612550001
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$477.50
Rate for Payer: AlohaCare Medicare	$725.80
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Devoted Health Medicare	$802.20
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	$725.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$907.25
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Humana Medicare	$725.80
Rate for Payer: Kaiser Permanente Commercial	$859.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$725.80
Rate for Payer: MDX Hawaii PPO	$926.35
Rate for Payer: Ohana Health Plan Medicaid	$725.80
Rate for Payer: Ohana Health Plan Medicare	$725.80
Rate for Payer: UnitedHealthcare Medicare	$725.80
Rate for Payer: University Health Alliance Commercial	$696.10

HC CLOSED RX RADIAL SHAFT FX W/DISLOCATION

Facility

$6,236.00

Service Code	HCPCS 25520
Hospital Charge Code	7612552001
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$6,048.92
Rate for Payer: AlohaCare Medicaid	$3,118.00
Rate for Payer: AlohaCare Medicare	$4,739.36
Rate for Payer: Cash Price	$3,741.60
Rate for Payer: Cash Price	$3,741.60
Rate for Payer: Devoted Health Medicare	$5,238.24
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	$4,739.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,924.20
Rate for Payer: Health Management Network Commercial	$5,300.60
Rate for Payer: Humana Medicare	$4,739.36
Rate for Payer: Kaiser Permanente Commercial	$5,612.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$4,739.36
Rate for Payer: MDX Hawaii PPO	$6,048.92
Rate for Payer: Ohana Health Plan Medicaid	$4,739.36
Rate for Payer: Ohana Health Plan Medicare	$4,739.36
Rate for Payer: UnitedHealthcare Medicare	$4,739.36
Rate for Payer: University Health Alliance Commercial	$4,545.42

HC CLOSED RX RADIAL SHAFT FX W/DISLOCATION

Facility

$6,236.00

Service Code	HCPCS 25520
Hospital Charge Code	7612552001
Hospital Revenue Code	450
Min. Negotiated Rate	$5,300.60
Max. Negotiated Rate	$6,048.92
Rate for Payer: Cash Price	$3,741.60
Rate for Payer: Health Management Network Commercial	$5,300.60
Rate for Payer: Kaiser Permanente Commercial	$5,612.40
Rate for Payer: MDX Hawaii PPO	$6,048.92

HC CLOSED RX SHLDR DISLOCATION

Facility

$955.00

Service Code	HCPCS 23650
Hospital Charge Code	7612365001
Hospital Revenue Code	761
Min. Negotiated Rate	$180.50
Max. Negotiated Rate	$926.35
Rate for Payer: AlohaCare Medicaid	$477.50
Rate for Payer: AlohaCare Medicare	$725.80
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Devoted Health Medicare	$802.20
Rate for Payer: Hawaii Medical Service Association Commercial	$315.01
Rate for Payer: Hawaii Medical Service Association Medicare	$725.80
Rate for Payer: Hawaii Western Management Group Commercial	$907.25
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Humana Medicare	$725.80
Rate for Payer: Kaiser Permanente Commercial	$859.50
Rate for Payer: Kaiser Permanente Medicaid	$487.05
Rate for Payer: Kaiser Permanente Medicare	$725.80
Rate for Payer: MDX Hawaii PPO	$926.35
Rate for Payer: Ohana Health Plan Medicaid	$725.80
Rate for Payer: Ohana Health Plan Medicare	$725.80
Rate for Payer: UnitedHealthcare Medicaid	$180.50
Rate for Payer: UnitedHealthcare Medicare	$725.80
Rate for Payer: University Health Alliance Commercial	$696.10

HC CLOSED RX SHLDR DISLOCATION

Facility

$955.00

Service Code	HCPCS 23650
Hospital Charge Code	7612365001
Hospital Revenue Code	761
Min. Negotiated Rate	$811.75
Max. Negotiated Rate	$926.35
Rate for Payer: Cash Price	$573.00
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Kaiser Permanente Commercial	$859.50
Rate for Payer: MDX Hawaii PPO	$926.35

HC CLOSED RX TALUS FX,MANIPULATN

Facility

$6,369.00

Service Code	HCPCS 28435
Hospital Charge Code	7612843501
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$6,177.93
Rate for Payer: AlohaCare Medicaid	$3,184.50
Rate for Payer: AlohaCare Medicare	$4,840.44
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Devoted Health Medicare	$5,349.96
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	$4,840.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
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	$4,840.44
Rate for Payer: Kaiser Permanente Commercial	$5,732.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$4,840.44
Rate for Payer: MDX Hawaii PPO	$6,177.93
Rate for Payer: Ohana Health Plan Medicaid	$4,840.44
Rate for Payer: Ohana Health Plan Medicare	$4,840.44
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,840.44
Rate for Payer: University Health Alliance Commercial	$4,642.36

HC CLOSED RX TALUS FX,MANIPULATN

Facility

$6,369.00

Service Code	HCPCS 28435
Hospital Charge Code	7612843501
Hospital Revenue Code	450
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 CLOSED RX TIBIAL PLATEAU FX

Facility

$935.00

Service Code	HCPCS 27530
Hospital Charge Code	7612753001
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$467.50
Rate for Payer: AlohaCare Medicare	$710.60
Rate for Payer: Cash Price	$561.00
Rate for Payer: Cash Price	$561.00
Rate for Payer: Devoted Health Medicare	$785.40
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	$710.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$888.25
Rate for Payer: Health Management Network Commercial	$794.75
Rate for Payer: Humana Medicare	$710.60
Rate for Payer: Kaiser Permanente Commercial	$841.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$710.60
Rate for Payer: MDX Hawaii PPO	$906.95
Rate for Payer: Ohana Health Plan Medicaid	$710.60
Rate for Payer: Ohana Health Plan Medicare	$710.60
Rate for Payer: UnitedHealthcare Medicare	$710.60
Rate for Payer: University Health Alliance Commercial	$681.52

HC CLOSED RX TIBIAL PLATEAU FX

Facility

$935.00

Service Code	HCPCS 27530
Hospital Charge Code	7612753001
Hospital Revenue Code	450
Min. Negotiated Rate	$794.75
Max. Negotiated Rate	$906.95
Rate for Payer: Cash Price	$561.00
Rate for Payer: Health Management Network Commercial	$794.75
Rate for Payer: Kaiser Permanente Commercial	$841.50
Rate for Payer: MDX Hawaii PPO	$906.95

HC CLOSED RX TIBIA SHAFT FX

Facility

$935.00

Service Code	HCPCS 27750
Hospital Charge Code	7612775001
Hospital Revenue Code	450
Min. Negotiated Rate	$794.75
Max. Negotiated Rate	$906.95
Rate for Payer: Cash Price	$561.00
Rate for Payer: Health Management Network Commercial	$794.75
Rate for Payer: Kaiser Permanente Commercial	$841.50
Rate for Payer: MDX Hawaii PPO	$906.95

HC CLOSED RX TIBIA SHAFT FX

Facility

$935.00

Service Code	HCPCS 27750
Hospital Charge Code	7612775001
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$467.50
Rate for Payer: AlohaCare Medicare	$710.60
Rate for Payer: Cash Price	$561.00
Rate for Payer: Cash Price	$561.00
Rate for Payer: Devoted Health Medicare	$785.40
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	$710.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$888.25
Rate for Payer: Health Management Network Commercial	$794.75
Rate for Payer: Humana Medicare	$710.60
Rate for Payer: Kaiser Permanente Commercial	$841.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$710.60
Rate for Payer: MDX Hawaii PPO	$906.95
Rate for Payer: Ohana Health Plan Medicaid	$710.60
Rate for Payer: Ohana Health Plan Medicare	$710.60
Rate for Payer: UnitedHealthcare Medicare	$710.60
Rate for Payer: University Health Alliance Commercial	$681.52

HC CLOSED RX TIBIA SHAFT FX,MANIPULATN

Facility

$6,369.00

Service Code	HCPCS 27752
Hospital Charge Code	7612775201
Hospital Revenue Code	450
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 CLOSED RX TIBIA SHAFT FX,MANIPULATN

Facility

$6,369.00

Service Code	HCPCS 27752
Hospital Charge Code	7612775201
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$6,177.93
Rate for Payer: AlohaCare Medicaid	$3,184.50
Rate for Payer: AlohaCare Medicare	$4,840.44
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Devoted Health Medicare	$5,349.96
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	$4,840.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
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	$4,840.44
Rate for Payer: Kaiser Permanente Commercial	$5,732.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$4,840.44
Rate for Payer: MDX Hawaii PPO	$6,177.93
Rate for Payer: Ohana Health Plan Medicaid	$4,840.44
Rate for Payer: Ohana Health Plan Medicare	$4,840.44
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,840.44
Rate for Payer: University Health Alliance Commercial	$4,035.20

HC CLOSED RX TIB PLAT FX+MANIP

Facility

$12,912.00

Service Code	HCPCS 27532
Hospital Charge Code	7612753201
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	$9,813.12
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Cash Price	$7,747.20
Rate for Payer: Devoted Health Medicare	$10,846.08
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	$9,813.12
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	$9,813.12
Rate for Payer: Kaiser Permanente Commercial	$11,620.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$9,813.12
Rate for Payer: MDX Hawaii PPO	$12,524.64
Rate for Payer: Ohana Health Plan Medicaid	$9,813.12
Rate for Payer: Ohana Health Plan Medicare	$9,813.12
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$9,813.12
Rate for Payer: University Health Alliance Commercial	$9,411.56

HC CLOSED RX TIB PLAT FX+MANIP

Facility

$12,912.00

Service Code	HCPCS 27532
Hospital Charge Code	7612753201
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 CLOSED RX TOE FX

Facility

$955.00

Service Code	HCPCS 28510
Hospital Charge Code	7612851001
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$477.50
Rate for Payer: AlohaCare Medicare	$725.80
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Devoted Health Medicare	$802.20
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	$725.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$907.25
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Humana Medicare	$725.80
Rate for Payer: Kaiser Permanente Commercial	$859.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$725.80
Rate for Payer: MDX Hawaii PPO	$926.35
Rate for Payer: Ohana Health Plan Medicaid	$725.80
Rate for Payer: Ohana Health Plan Medicare	$725.80
Rate for Payer: UnitedHealthcare Medicare	$725.80
Rate for Payer: University Health Alliance Commercial	$696.10

HC CLOSED RX TOE FX

Facility

$955.00

Service Code	HCPCS 28510
Hospital Charge Code	7612851001
Hospital Revenue Code	450
Min. Negotiated Rate	$811.75
Max. Negotiated Rate	$926.35
Rate for Payer: Cash Price	$573.00
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Kaiser Permanente Commercial	$859.50
Rate for Payer: MDX Hawaii PPO	$926.35

HC CLOSED RX TRAUMA HIP DISLOC,ANESTH

Facility

$6,369.00

Service Code	HCPCS 27252
Hospital Charge Code	7612725201
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$6,177.93
Rate for Payer: AlohaCare Medicaid	$3,184.50
Rate for Payer: AlohaCare Medicare	$4,840.44
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Devoted Health Medicare	$5,349.96
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	$4,840.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
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	$4,840.44
Rate for Payer: Kaiser Permanente Commercial	$5,732.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$4,840.44
Rate for Payer: MDX Hawaii PPO	$6,177.93
Rate for Payer: Ohana Health Plan Medicaid	$4,840.44
Rate for Payer: Ohana Health Plan Medicare	$4,840.44
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$4,840.44
Rate for Payer: University Health Alliance Commercial	$5,160.40

Know your out-of-pocket cost for care.

All Charges