Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

SGOT (AST) DLS

Facility

$72.00

Service Code	HCPCS 84450
Hospital Charge Code	422844505
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$36.00
Rate for Payer: AlohaCare Medicare	$30.24
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$66.24
Rate for Payer: Devoted Health Medicare	$30.24
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.14
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$30.24
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$30.24
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$30.24
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$30.24
Rate for Payer: Ohana Health Plan Medicare	$30.24
Rate for Payer: UnitedHealthcare Medicaid	$7.14
Rate for Payer: UnitedHealthcare Medicare	$30.24
Rate for Payer: University Health Alliance Commercial	$13.36

SGOT (AST) DLS

Facility

$72.00

Service Code	HCPCS 84450
Hospital Charge Code	422844505
Hospital Revenue Code	301
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: MDX Hawaii PPO	$69.84

SGPT (ALT) DLS

Facility

$21.00

Service Code	HCPCS 84460
Hospital Charge Code	422844605
Hospital Revenue Code	301
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$20.37
Rate for Payer: AlohaCare Medicaid	$10.50
Rate for Payer: AlohaCare Medicare	$8.82
Rate for Payer: Cash Price	$13.65
Rate for Payer: Cash Price	$13.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$19.32
Rate for Payer: Devoted Health Medicare	$8.82
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.32
Rate for Payer: Hawaii Medical Service Association Commercial	$6.62
Rate for Payer: Hawaii Medical Service Association Medicare	$8.82
Rate for Payer: Hawaii Western Management Group Commercial	$5.30
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Humana Medicare	$8.82
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicare	$8.82
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: Ohana Health Plan Medicaid	$8.82
Rate for Payer: Ohana Health Plan Medicare	$8.82
Rate for Payer: UnitedHealthcare Medicaid	$7.32
Rate for Payer: UnitedHealthcare Medicare	$8.82
Rate for Payer: University Health Alliance Commercial	$13.69

SGPT (ALT) DLS

Facility

$21.00

Service Code	HCPCS 84460
Hospital Charge Code	422844605
Hospital Revenue Code	301
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$13.65
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: MDX Hawaii PPO	$20.37

SHAVING OF EPIDERMAL OR DERMAL LESION SINGLE TRUNK

Facility

$429.00

Service Code	HCPCS 11300
Hospital Charge Code	440113000
Hospital Revenue Code	450
Min. Negotiated Rate	$364.65
Max. Negotiated Rate	$416.13
Rate for Payer: Cash Price	$278.85
Rate for Payer: Health Management Network Commercial	$364.65
Rate for Payer: Kaiser Permanente Commercial	$386.10
Rate for Payer: MDX Hawaii PPO	$416.13

SHAVING OF EPIDERMAL OR DERMAL LESION SINGLE TRUNK

Facility

$429.00

Service Code	HCPCS 11300
Hospital Charge Code	440113000
Hospital Revenue Code	450
Min. Negotiated Rate	$180.18
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$214.50
Rate for Payer: AlohaCare Medicare	$180.18
Rate for Payer: Cash Price	$278.85
Rate for Payer: Cash Price	$278.85
Rate for Payer: Cash Price	$278.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$394.68
Rate for Payer: Devoted Health Medicare	$180.18
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$180.18
Rate for Payer: Hawaii Western Management Group Commercial	$407.55
Rate for Payer: Health Management Network Commercial	$364.65
Rate for Payer: Humana Medicare	$180.18
Rate for Payer: Kaiser Permanente Commercial	$386.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$180.18
Rate for Payer: MDX Hawaii PPO	$416.13
Rate for Payer: Ohana Health Plan Medicaid	$180.18
Rate for Payer: Ohana Health Plan Medicare	$180.18
Rate for Payer: UnitedHealthcare Medicare	$180.18
Rate for Payer: University Health Alliance Commercial	$312.70

SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<

Professional

Both

$307.00

Service Code	HCPCS 11310
Hospital Revenue Code	361
Min. Negotiated Rate	$36.52
Max. Negotiated Rate	$260.95
Rate for Payer: AlohaCare Medicaid	$45.90
Rate for Payer: AlohaCare Medicare	$36.52
Rate for Payer: Cash Price	$199.55
Rate for Payer: Cash Price	$199.55
Rate for Payer: Devoted Health Medicare	$36.52
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$45.90
Rate for Payer: Hawaii Medical Service Association Commercial	$71.21
Rate for Payer: Hawaii Medical Service Association Medicare	$36.52
Rate for Payer: Hawaii Western Management Group Commercial	$58.24
Rate for Payer: Health Management Network Commercial	$260.95
Rate for Payer: Kaiser Permanente Commercial	$43.82
Rate for Payer: Kaiser Permanente Medicaid	$43.82
Rate for Payer: Kaiser Permanente Medicare	$43.82
Rate for Payer: Ohana Health Plan Medicaid	$45.90
Rate for Payer: Ohana Health Plan Medicare	$36.52
Rate for Payer: UnitedHealthcare Medicaid	$45.90
Rate for Payer: UnitedHealthcare Medicare	$36.52
Rate for Payer: University Health Alliance Commercial	$52.69

SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM

Professional

Both

$540.00

Service Code	HCPCS 11313
Hospital Revenue Code	361
Min. Negotiated Rate	$77.05
Max. Negotiated Rate	$459.00
Rate for Payer: AlohaCare Medicaid	$96.95
Rate for Payer: AlohaCare Medicare	$77.05
Rate for Payer: Cash Price	$351.00
Rate for Payer: Cash Price	$351.00
Rate for Payer: Devoted Health Medicare	$77.05
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$96.95
Rate for Payer: Hawaii Medical Service Association Commercial	$150.51
Rate for Payer: Hawaii Medical Service Association Medicare	$77.05
Rate for Payer: Hawaii Western Management Group Commercial	$85.80
Rate for Payer: Health Management Network Commercial	$459.00
Rate for Payer: Kaiser Permanente Commercial	$92.46
Rate for Payer: Kaiser Permanente Medicaid	$92.46
Rate for Payer: Kaiser Permanente Medicare	$92.46
Rate for Payer: Ohana Health Plan Medicaid	$96.95
Rate for Payer: Ohana Health Plan Medicare	$77.05
Rate for Payer: UnitedHealthcare Medicaid	$96.95
Rate for Payer: UnitedHealthcare Medicare	$77.05
Rate for Payer: University Health Alliance Commercial	$111.38

SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<

Professional

Both

$307.00

Service Code	HCPCS 11305
Hospital Revenue Code	361
Min. Negotiated Rate	$32.34
Max. Negotiated Rate	$260.95
Rate for Payer: AlohaCare Medicaid	$37.12
Rate for Payer: AlohaCare Medicare	$32.34
Rate for Payer: Cash Price	$199.55
Rate for Payer: Cash Price	$199.55
Rate for Payer: Devoted Health Medicare	$32.34
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$37.12
Rate for Payer: Hawaii Medical Service Association Commercial	$58.98
Rate for Payer: Hawaii Medical Service Association Medicare	$32.34
Rate for Payer: Hawaii Western Management Group Commercial	$47.58
Rate for Payer: Health Management Network Commercial	$260.95
Rate for Payer: Kaiser Permanente Commercial	$38.81
Rate for Payer: Kaiser Permanente Medicaid	$38.81
Rate for Payer: Kaiser Permanente Medicare	$38.81
Rate for Payer: Ohana Health Plan Medicaid	$37.12
Rate for Payer: Ohana Health Plan Medicare	$32.34
Rate for Payer: UnitedHealthcare Medicaid	$37.12
Rate for Payer: UnitedHealthcare Medicare	$32.34
Rate for Payer: University Health Alliance Commercial	$43.65

SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM

Professional

Both

$307.00

Service Code	HCPCS 11306
Hospital Revenue Code	361
Min. Negotiated Rate	$40.54
Max. Negotiated Rate	$260.95
Rate for Payer: AlohaCare Medicaid	$48.94
Rate for Payer: AlohaCare Medicare	$40.54
Rate for Payer: Cash Price	$199.55
Rate for Payer: Cash Price	$199.55
Rate for Payer: Devoted Health Medicare	$40.54
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$48.94
Rate for Payer: Hawaii Medical Service Association Commercial	$76.62
Rate for Payer: Hawaii Medical Service Association Medicare	$40.54
Rate for Payer: Hawaii Western Management Group Commercial	$47.58
Rate for Payer: Health Management Network Commercial	$260.95
Rate for Payer: Kaiser Permanente Commercial	$48.65
Rate for Payer: Kaiser Permanente Medicaid	$48.65
Rate for Payer: Kaiser Permanente Medicare	$48.65
Rate for Payer: Ohana Health Plan Medicaid	$48.94
Rate for Payer: Ohana Health Plan Medicare	$40.54
Rate for Payer: UnitedHealthcare Medicaid	$48.94
Rate for Payer: UnitedHealthcare Medicare	$40.54
Rate for Payer: University Health Alliance Commercial	$56.70

SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM

Professional

Both

$307.00

Service Code	HCPCS 11307
Hospital Revenue Code	361
Min. Negotiated Rate	$51.08
Max. Negotiated Rate	$260.95
Rate for Payer: AlohaCare Medicaid	$62.46
Rate for Payer: AlohaCare Medicare	$51.08
Rate for Payer: Cash Price	$199.55
Rate for Payer: Cash Price	$199.55
Rate for Payer: Devoted Health Medicare	$51.08
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$62.46
Rate for Payer: Hawaii Medical Service Association Commercial	$98.22
Rate for Payer: Hawaii Medical Service Association Medicare	$51.08
Rate for Payer: Hawaii Western Management Group Commercial	$71.50
Rate for Payer: Health Management Network Commercial	$260.95
Rate for Payer: Kaiser Permanente Commercial	$61.30
Rate for Payer: Kaiser Permanente Medicaid	$61.30
Rate for Payer: Kaiser Permanente Medicare	$61.30
Rate for Payer: Ohana Health Plan Medicaid	$62.46
Rate for Payer: Ohana Health Plan Medicare	$51.08
Rate for Payer: UnitedHealthcare Medicaid	$62.46
Rate for Payer: UnitedHealthcare Medicare	$51.08
Rate for Payer: University Health Alliance Commercial	$72.68

SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM

Professional

Both

$540.00

Service Code	HCPCS 11308
Hospital Revenue Code	361
Min. Negotiated Rate	$59.06
Max. Negotiated Rate	$459.00
Rate for Payer: AlohaCare Medicaid	$69.39
Rate for Payer: AlohaCare Medicare	$59.06
Rate for Payer: Cash Price	$351.00
Rate for Payer: Cash Price	$351.00
Rate for Payer: Devoted Health Medicare	$59.06
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$69.39
Rate for Payer: Hawaii Medical Service Association Commercial	$109.83
Rate for Payer: Hawaii Medical Service Association Medicare	$59.06
Rate for Payer: Hawaii Western Management Group Commercial	$66.82
Rate for Payer: Health Management Network Commercial	$459.00
Rate for Payer: Kaiser Permanente Commercial	$70.87
Rate for Payer: Kaiser Permanente Medicaid	$70.87
Rate for Payer: Kaiser Permanente Medicare	$70.87
Rate for Payer: Ohana Health Plan Medicaid	$69.39
Rate for Payer: Ohana Health Plan Medicare	$59.06
Rate for Payer: UnitedHealthcare Medicaid	$69.39
Rate for Payer: UnitedHealthcare Medicare	$59.06
Rate for Payer: University Health Alliance Commercial	$81.27

Shingrix (zoster vaccine) 0.5 mL inj [KMC]

Facility

$692.16

Service Code	NDC 58160082311
Hospital Revenue Code	250
Min. Negotiated Rate	$290.71
Max. Negotiated Rate	$671.40
Rate for Payer: AlohaCare Medicaid	$346.08
Rate for Payer: AlohaCare Medicare	$290.71
Rate for Payer: Cash Price	$449.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$636.79
Rate for Payer: Devoted Health Medicare	$290.71
Rate for Payer: Hawaii Medical Service Association Medicare	$290.71
Rate for Payer: Hawaii Western Management Group Commercial	$657.55
Rate for Payer: Health Management Network Commercial	$588.34
Rate for Payer: Humana Medicare	$290.71
Rate for Payer: Kaiser Permanente Commercial	$622.94
Rate for Payer: Kaiser Permanente Medicaid	$353.00
Rate for Payer: Kaiser Permanente Medicare	$290.71
Rate for Payer: MDX Hawaii PPO	$671.40
Rate for Payer: Ohana Health Plan Medicaid	$290.71
Rate for Payer: Ohana Health Plan Medicare	$290.71
Rate for Payer: UnitedHealthcare Medicaid	$415.30
Rate for Payer: UnitedHealthcare Medicare	$290.71
Rate for Payer: University Health Alliance Commercial	$504.52

Shingrix (zoster vaccine) 0.5 mL inj [KMC]

Facility

$692.16

Service Code	NDC 58160082311
Hospital Revenue Code	250
Min. Negotiated Rate	$588.34
Max. Negotiated Rate	$671.40
Rate for Payer: Cash Price	$449.90
Rate for Payer: Health Management Network Commercial	$588.34
Rate for Payer: Kaiser Permanente Commercial	$622.94
Rate for Payer: MDX Hawaii PPO	$671.40

SHOULDER 1 VW

Facility

$369.00

Service Code	HCPCS 73020
Hospital Charge Code	424730200
Hospital Revenue Code	320
Min. Negotiated Rate	$15.78
Max. Negotiated Rate	$357.93
Rate for Payer: AlohaCare Medicaid	$184.50
Rate for Payer: AlohaCare Medicare	$154.98
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$239.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$339.48
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$15.78
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Humana Medicare	$154.98
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: Kaiser Permanente Medicaid	$188.19
Rate for Payer: Kaiser Permanente Medicare	$154.98
Rate for Payer: MDX Hawaii PPO	$357.93
Rate for Payer: Ohana Health Plan Medicaid	$154.98
Rate for Payer: Ohana Health Plan Medicare	$154.98
Rate for Payer: UnitedHealthcare Medicaid	$15.78
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$49.15

SHOULDER 1 VW

Facility

$369.00

Service Code	HCPCS 73020
Hospital Charge Code	424730200
Hospital Revenue Code	320
Min. Negotiated Rate	$313.65
Max. Negotiated Rate	$357.93
Rate for Payer: Cash Price	$239.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: MDX Hawaii PPO	$357.93

SHOULDER COMPLETE MIN 2 VWS

Facility

$369.00

Service Code	HCPCS 73030
Hospital Charge Code	424730300
Hospital Revenue Code	320
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$357.93
Rate for Payer: AlohaCare Medicaid	$184.50
Rate for Payer: AlohaCare Medicare	$154.98
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$239.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$339.48
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.84
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Humana Medicare	$154.98
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: Kaiser Permanente Medicaid	$188.19
Rate for Payer: Kaiser Permanente Medicare	$154.98
Rate for Payer: MDX Hawaii PPO	$357.93
Rate for Payer: Ohana Health Plan Medicaid	$154.98
Rate for Payer: Ohana Health Plan Medicare	$154.98
Rate for Payer: UnitedHealthcare Medicaid	$18.84
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$61.92

SHOULDER COMPLETE MIN 2 VWS

Facility

$369.00

Service Code	HCPCS 73030
Hospital Charge Code	424730300
Hospital Revenue Code	320
Min. Negotiated Rate	$313.65
Max. Negotiated Rate	$357.93
Rate for Payer: Cash Price	$239.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: MDX Hawaii PPO	$357.93

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC

Facility

$23,180.56

Service Code	MSDRG 511
Min. Negotiated Rate	$23,180.56
Max. Negotiated Rate	$23,180.56
Rate for Payer: Hawaii Medical Service Association Commercial	$23,180.56

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC

Facility

$23,180.56

Service Code	MSDRG 510
Min. Negotiated Rate	$23,180.56
Max. Negotiated Rate	$23,180.56
Rate for Payer: Hawaii Medical Service Association Commercial	$23,180.56

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$21,782.14

Service Code	MSDRG 512
Min. Negotiated Rate	$21,782.14
Max. Negotiated Rate	$21,782.14
Rate for Payer: Hawaii Medical Service Association Commercial	$21,782.14

SHOULDER IMMOBILIZER LG

Facility

$27.00

Hospital Charge Code	8263
Hospital Revenue Code	270
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$17.55
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Kaiser Permanente Commercial	$24.30
Rate for Payer: MDX Hawaii PPO	$26.19

SHOULDER IMMOBILIZER LG

Facility

$27.00

Hospital Charge Code	8263
Hospital Revenue Code	270
Min. Negotiated Rate	$11.34
Max. Negotiated Rate	$26.19
Rate for Payer: AlohaCare Medicaid	$13.50
Rate for Payer: AlohaCare Medicare	$11.34
Rate for Payer: Cash Price	$17.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$24.84
Rate for Payer: Devoted Health Medicare	$11.34
Rate for Payer: Hawaii Medical Service Association Medicare	$11.34
Rate for Payer: Hawaii Western Management Group Commercial	$25.65
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Humana Medicare	$11.34
Rate for Payer: Kaiser Permanente Commercial	$24.30
Rate for Payer: Kaiser Permanente Medicaid	$13.77
Rate for Payer: Kaiser Permanente Medicare	$11.34
Rate for Payer: MDX Hawaii PPO	$26.19
Rate for Payer: Ohana Health Plan Medicaid	$11.34
Rate for Payer: Ohana Health Plan Medicare	$11.34
Rate for Payer: UnitedHealthcare Medicare	$11.34
Rate for Payer: University Health Alliance Commercial	$19.68

SHOULDER IMMOBILIZER MED

Facility

$18.00

Hospital Charge Code	8264
Hospital Revenue Code	270
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$17.46
Rate for Payer: AlohaCare Medicaid	$9.00
Rate for Payer: AlohaCare Medicare	$7.56
Rate for Payer: Cash Price	$11.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$16.56
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Hawaii Medical Service Association Medicare	$7.56
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Humana Medicare	$7.56
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: Kaiser Permanente Medicare	$7.56
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: Ohana Health Plan Medicaid	$7.56
Rate for Payer: Ohana Health Plan Medicare	$7.56
Rate for Payer: UnitedHealthcare Medicare	$7.56
Rate for Payer: University Health Alliance Commercial	$13.12

SHOULDER IMMOBILIZER MED

Facility

$18.00

Hospital Charge Code	8264
Hospital Revenue Code	270
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$11.70
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: MDX Hawaii PPO	$17.46

Know your out-of-pocket cost for care.

All Charges