Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

440260370 DECOMPRESSIVE FASCIOTOMY HAND ED Charges

Facility

$6,387.00

Service Code	HCPCS 26037
Hospital Charge Code	440260370
Hospital Revenue Code	450
Min. Negotiated Rate	$5,428.95
Max. Negotiated Rate	$6,195.39
Rate for Payer: Cash Price	$4,151.55
Rate for Payer: Health Management Network Commercial	$5,428.95
Rate for Payer: Kaiser Permanente Commercial	$5,748.30
Rate for Payer: MDX Hawaii PPO	$6,195.39

440260700 ARTHROTOMY CARPOMETACARP ED Charges

Facility

$6,387.00

Service Code	HCPCS 26070
Hospital Charge Code	440260700
Hospital Revenue Code	450
Min. Negotiated Rate	$5,428.95
Max. Negotiated Rate	$6,195.39
Rate for Payer: Cash Price	$4,151.55
Rate for Payer: Health Management Network Commercial	$5,428.95
Rate for Payer: Kaiser Permanente Commercial	$5,748.30
Rate for Payer: MDX Hawaii PPO	$6,195.39

440260700 ARTHROTOMY CARPOMETACARP ED Charges

Facility

$6,387.00

Service Code	HCPCS 26070
Hospital Charge Code	440260700
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$6,195.39
Rate for Payer: AlohaCare Medicaid	$3,193.50
Rate for Payer: AlohaCare Medicare	$2,682.54
Rate for Payer: Cash Price	$4,151.55
Rate for Payer: Cash Price	$4,151.55
Rate for Payer: Cash Price	$4,151.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5,876.04
Rate for Payer: Devoted Health Medicare	$2,682.54
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	$2,682.54
Rate for Payer: Hawaii Western Management Group Commercial	$6,067.65
Rate for Payer: Health Management Network Commercial	$5,428.95
Rate for Payer: Humana Medicare	$2,682.54
Rate for Payer: Kaiser Permanente Commercial	$5,748.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,682.54
Rate for Payer: MDX Hawaii PPO	$6,195.39
Rate for Payer: Ohana Health Plan Medicaid	$2,682.54
Rate for Payer: Ohana Health Plan Medicare	$2,682.54
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,682.54
Rate for Payer: University Health Alliance Commercial	$5,160.40

440266070 CLS TRT METCRPL FX EXT FIX EA BONE ED Ch

Facility

$6,394.00

Service Code	HCPCS 26607
Hospital Charge Code	440266070
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$6,202.18
Rate for Payer: AlohaCare Medicaid	$3,197.00
Rate for Payer: AlohaCare Medicare	$2,685.48
Rate for Payer: Cash Price	$4,156.10
Rate for Payer: Cash Price	$4,156.10
Rate for Payer: Cash Price	$4,156.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5,882.48
Rate for Payer: Devoted Health Medicare	$2,685.48
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	$2,685.48
Rate for Payer: Hawaii Western Management Group Commercial	$6,074.30
Rate for Payer: Health Management Network Commercial	$5,434.90
Rate for Payer: Humana Medicare	$2,685.48
Rate for Payer: Kaiser Permanente Commercial	$5,754.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,685.48
Rate for Payer: MDX Hawaii PPO	$6,202.18
Rate for Payer: Ohana Health Plan Medicaid	$2,685.48
Rate for Payer: Ohana Health Plan Medicare	$2,685.48
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,685.48
Rate for Payer: University Health Alliance Commercial	$4,035.20

440266070 CLS TRT METCRPL FX EXT FIX EA BONE ED Ch

Facility

$6,394.00

Service Code	HCPCS 26607
Hospital Charge Code	440266070
Hospital Revenue Code	450
Min. Negotiated Rate	$5,434.90
Max. Negotiated Rate	$6,202.18
Rate for Payer: Cash Price	$4,156.10
Rate for Payer: Health Management Network Commercial	$5,434.90
Rate for Payer: Kaiser Permanente Commercial	$5,754.60
Rate for Payer: MDX Hawaii PPO	$6,202.18

440269900 I&D PLVIS JNT DEEP ABS ED Charges

Facility

$8,371.00

Service Code	HCPCS 26990
Hospital Charge Code	440269900
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$8,119.87
Rate for Payer: AlohaCare Medicaid	$4,185.50
Rate for Payer: AlohaCare Medicare	$3,515.82
Rate for Payer: Cash Price	$5,441.15
Rate for Payer: Cash Price	$5,441.15
Rate for Payer: Cash Price	$5,441.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7,701.32
Rate for Payer: Devoted Health Medicare	$3,515.82
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	$3,515.82
Rate for Payer: Hawaii Western Management Group Commercial	$7,952.45
Rate for Payer: Health Management Network Commercial	$7,115.35
Rate for Payer: Humana Medicare	$3,515.82
Rate for Payer: Kaiser Permanente Commercial	$7,533.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,515.82
Rate for Payer: MDX Hawaii PPO	$8,119.87
Rate for Payer: Ohana Health Plan Medicaid	$3,515.82
Rate for Payer: Ohana Health Plan Medicare	$3,515.82
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,515.82
Rate for Payer: University Health Alliance Commercial	$4,035.20

440269900 I&D PLVIS JNT DEEP ABS ED Charges

Facility

$8,371.00

Service Code	HCPCS 26990
Hospital Charge Code	440269900
Hospital Revenue Code	450
Min. Negotiated Rate	$7,115.35
Max. Negotiated Rate	$8,119.87
Rate for Payer: Cash Price	$5,441.15
Rate for Payer: Health Management Network Commercial	$7,115.35
Rate for Payer: Kaiser Permanente Commercial	$7,533.90
Rate for Payer: MDX Hawaii PPO	$8,119.87

440269910 I&D PELVIS, HIP INFECTED BURSA ED Charge

Facility

$8,371.00

Service Code	HCPCS 26991
Hospital Charge Code	440269910
Hospital Revenue Code	450
Min. Negotiated Rate	$7,115.35
Max. Negotiated Rate	$8,119.87
Rate for Payer: Cash Price	$5,441.15
Rate for Payer: Health Management Network Commercial	$7,115.35
Rate for Payer: Kaiser Permanente Commercial	$7,533.90
Rate for Payer: MDX Hawaii PPO	$8,119.87

440269910 I&D PELVIS, HIP INFECTED BURSA ED Charge

Facility

$8,371.00

Service Code	HCPCS 26991
Hospital Charge Code	440269910
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$8,119.87
Rate for Payer: AlohaCare Medicaid	$4,185.50
Rate for Payer: AlohaCare Medicare	$3,515.82
Rate for Payer: Cash Price	$5,441.15
Rate for Payer: Cash Price	$5,441.15
Rate for Payer: Cash Price	$5,441.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7,701.32
Rate for Payer: Devoted Health Medicare	$3,515.82
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	$3,515.82
Rate for Payer: Hawaii Western Management Group Commercial	$7,952.45
Rate for Payer: Health Management Network Commercial	$7,115.35
Rate for Payer: Humana Medicare	$3,515.82
Rate for Payer: Kaiser Permanente Commercial	$7,533.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,515.82
Rate for Payer: MDX Hawaii PPO	$8,119.87
Rate for Payer: Ohana Health Plan Medicaid	$3,515.82
Rate for Payer: Ohana Health Plan Medicare	$3,515.82
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,515.82
Rate for Payer: University Health Alliance Commercial	$4,035.20

440273010 I&D DEEP THIGH KNEE REG ED Charges

Facility

$8,013.00

Service Code	HCPCS 27301
Hospital Charge Code	440273010
Hospital Revenue Code	450
Min. Negotiated Rate	$6,811.05
Max. Negotiated Rate	$7,772.61
Rate for Payer: Cash Price	$5,208.45
Rate for Payer: Health Management Network Commercial	$6,811.05
Rate for Payer: Kaiser Permanente Commercial	$7,211.70
Rate for Payer: MDX Hawaii PPO	$7,772.61

440273010 I&D DEEP THIGH KNEE REG ED Charges

Facility

$8,013.00

Service Code	HCPCS 27301
Hospital Charge Code	440273010
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$7,772.61
Rate for Payer: AlohaCare Medicaid	$4,006.50
Rate for Payer: AlohaCare Medicare	$3,365.46
Rate for Payer: Cash Price	$5,208.45
Rate for Payer: Cash Price	$5,208.45
Rate for Payer: Cash Price	$5,208.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7,371.96
Rate for Payer: Devoted Health Medicare	$3,365.46
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	$3,365.46
Rate for Payer: Hawaii Western Management Group Commercial	$7,612.35
Rate for Payer: Health Management Network Commercial	$6,811.05
Rate for Payer: Humana Medicare	$3,365.46
Rate for Payer: Kaiser Permanente Commercial	$7,211.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,365.46
Rate for Payer: MDX Hawaii PPO	$7,772.61
Rate for Payer: Ohana Health Plan Medicaid	$3,365.46
Rate for Payer: Ohana Health Plan Medicare	$3,365.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,365.46
Rate for Payer: University Health Alliance Commercial	$6,743.44

440276040 DRAIN LOWER LEG BURSA-INFECTED ED Charge

Facility

$13,151.00

Service Code	HCPCS 27604
Hospital Charge Code	440276040
Hospital Revenue Code	450
Min. Negotiated Rate	$11,178.35
Max. Negotiated Rate	$12,756.47
Rate for Payer: Cash Price	$8,548.15
Rate for Payer: Health Management Network Commercial	$11,178.35
Rate for Payer: Kaiser Permanente Commercial	$11,835.90
Rate for Payer: MDX Hawaii PPO	$12,756.47

440276040 DRAIN LOWER LEG BURSA-INFECTED ED Charge

Facility

$13,151.00

Service Code	HCPCS 27604
Hospital Charge Code	440276040
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$12,756.47
Rate for Payer: AlohaCare Medicaid	$6,575.50
Rate for Payer: AlohaCare Medicare	$5,523.42
Rate for Payer: Cash Price	$8,548.15
Rate for Payer: Cash Price	$8,548.15
Rate for Payer: Cash Price	$8,548.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$12,098.92
Rate for Payer: Devoted Health Medicare	$5,523.42
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	$5,523.42
Rate for Payer: Hawaii Western Management Group Commercial	$12,493.45
Rate for Payer: Health Management Network Commercial	$11,178.35
Rate for Payer: Humana Medicare	$5,523.42
Rate for Payer: Kaiser Permanente Commercial	$11,835.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$5,523.42
Rate for Payer: MDX Hawaii PPO	$12,756.47
Rate for Payer: Ohana Health Plan Medicaid	$5,523.42
Rate for Payer: Ohana Health Plan Medicare	$5,523.42
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$5,523.42
Rate for Payer: University Health Alliance Commercial	$5,160.40

440277660 OPN TX OF ANKLE FX MEDIAL MAL ED Charge

Facility

$21,060.00

Service Code	HCPCS 27766
Hospital Charge Code	440277660
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$20,428.20
Rate for Payer: AlohaCare Medicaid	$10,530.00
Rate for Payer: AlohaCare Medicare	$8,845.20
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$19,375.20
Rate for Payer: Devoted Health Medicare	$8,845.20
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	$8,845.20
Rate for Payer: Hawaii Western Management Group Commercial	$20,007.00
Rate for Payer: Health Management Network Commercial	$17,901.00
Rate for Payer: Humana Medicare	$8,845.20
Rate for Payer: Kaiser Permanente Commercial	$18,954.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$8,845.20
Rate for Payer: MDX Hawaii PPO	$20,428.20
Rate for Payer: Ohana Health Plan Medicaid	$8,845.20
Rate for Payer: Ohana Health Plan Medicare	$8,845.20
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$8,845.20
Rate for Payer: University Health Alliance Commercial	$6,743.44

440277660 OPN TX OF ANKLE FX MEDIAL MAL ED Charge

Facility

$21,060.00

Service Code	HCPCS 27766
Hospital Charge Code	440277660
Hospital Revenue Code	450
Min. Negotiated Rate	$17,901.00
Max. Negotiated Rate	$20,428.20
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Health Management Network Commercial	$17,901.00
Rate for Payer: Kaiser Permanente Commercial	$18,954.00
Rate for Payer: MDX Hawaii PPO	$20,428.20

440277840 OPN TRT PROX FIBULA FX W INT FIX ED Char

Facility

$21,060.00

Service Code	HCPCS 27784
Hospital Charge Code	440277840
Hospital Revenue Code	450
Min. Negotiated Rate	$17,901.00
Max. Negotiated Rate	$20,428.20
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Health Management Network Commercial	$17,901.00
Rate for Payer: Kaiser Permanente Commercial	$18,954.00
Rate for Payer: MDX Hawaii PPO	$20,428.20

440277840 OPN TRT PROX FIBULA FX W INT FIX ED Char

Facility

$21,060.00

Service Code	HCPCS 27784
Hospital Charge Code	440277840
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$20,428.20
Rate for Payer: AlohaCare Medicaid	$10,530.00
Rate for Payer: AlohaCare Medicare	$8,845.20
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$19,375.20
Rate for Payer: Devoted Health Medicare	$8,845.20
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	$8,845.20
Rate for Payer: Hawaii Western Management Group Commercial	$20,007.00
Rate for Payer: Health Management Network Commercial	$17,901.00
Rate for Payer: Humana Medicare	$8,845.20
Rate for Payer: Kaiser Permanente Commercial	$18,954.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$8,845.20
Rate for Payer: MDX Hawaii PPO	$20,428.20
Rate for Payer: Ohana Health Plan Medicaid	$8,845.20
Rate for Payer: Ohana Health Plan Medicare	$8,845.20
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$8,845.20
Rate for Payer: University Health Alliance Commercial	$6,743.44

440277920 OPN TRT DIST FIB FX INC FXTN ED Charge

Facility

$21,060.00

Service Code	HCPCS 27792
Hospital Charge Code	440277920
Hospital Revenue Code	450
Min. Negotiated Rate	$17,901.00
Max. Negotiated Rate	$20,428.20
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Health Management Network Commercial	$17,901.00
Rate for Payer: Kaiser Permanente Commercial	$18,954.00
Rate for Payer: MDX Hawaii PPO	$20,428.20

440277920 OPN TRT DIST FIB FX INC FXTN ED Charge

Facility

$21,060.00

Service Code	HCPCS 27792
Hospital Charge Code	440277920
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$20,428.20
Rate for Payer: AlohaCare Medicaid	$10,530.00
Rate for Payer: AlohaCare Medicare	$8,845.20
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$19,375.20
Rate for Payer: Devoted Health Medicare	$8,845.20
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	$8,845.20
Rate for Payer: Hawaii Western Management Group Commercial	$20,007.00
Rate for Payer: Health Management Network Commercial	$17,901.00
Rate for Payer: Humana Medicare	$8,845.20
Rate for Payer: Kaiser Permanente Commercial	$18,954.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$8,845.20
Rate for Payer: MDX Hawaii PPO	$20,428.20
Rate for Payer: Ohana Health Plan Medicaid	$8,845.20
Rate for Payer: Ohana Health Plan Medicare	$8,845.20
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$8,845.20
Rate for Payer: University Health Alliance Commercial	$6,743.44

440278140 OPEN TRT BIMALLEOLAR ANKLE FX ED Charge

Facility

$21,060.00

Service Code	HCPCS 27814
Hospital Charge Code	440278140
Hospital Revenue Code	450
Min. Negotiated Rate	$17,901.00
Max. Negotiated Rate	$20,428.20
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Health Management Network Commercial	$17,901.00
Rate for Payer: Kaiser Permanente Commercial	$18,954.00
Rate for Payer: MDX Hawaii PPO	$20,428.20

440278140 OPEN TRT BIMALLEOLAR ANKLE FX ED Charge

Facility

$21,060.00

Service Code	HCPCS 27814
Hospital Charge Code	440278140
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$20,428.20
Rate for Payer: AlohaCare Medicaid	$10,530.00
Rate for Payer: AlohaCare Medicare	$8,845.20
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$19,375.20
Rate for Payer: Devoted Health Medicare	$8,845.20
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	$8,845.20
Rate for Payer: Hawaii Western Management Group Commercial	$20,007.00
Rate for Payer: Health Management Network Commercial	$17,901.00
Rate for Payer: Humana Medicare	$8,845.20
Rate for Payer: Kaiser Permanente Commercial	$18,954.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$8,845.20
Rate for Payer: MDX Hawaii PPO	$20,428.20
Rate for Payer: Ohana Health Plan Medicaid	$8,845.20
Rate for Payer: Ohana Health Plan Medicare	$8,845.20
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$8,845.20
Rate for Payer: University Health Alliance Commercial	$6,743.44

440278220 OPEN TX TRIMALLEOLAR ANKLE FX INCL FIX E

Facility

$21,060.00

Service Code	HCPCS 27822
Hospital Charge Code	440278220
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$20,428.20
Rate for Payer: AlohaCare Medicaid	$10,530.00
Rate for Payer: AlohaCare Medicare	$8,845.20
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$19,375.20
Rate for Payer: Devoted Health Medicare	$8,845.20
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	$8,845.20
Rate for Payer: Hawaii Western Management Group Commercial	$20,007.00
Rate for Payer: Health Management Network Commercial	$17,901.00
Rate for Payer: Humana Medicare	$8,845.20
Rate for Payer: Kaiser Permanente Commercial	$18,954.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$8,845.20
Rate for Payer: MDX Hawaii PPO	$20,428.20
Rate for Payer: Ohana Health Plan Medicaid	$8,845.20
Rate for Payer: Ohana Health Plan Medicare	$8,845.20
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$8,845.20
Rate for Payer: University Health Alliance Commercial	$6,743.44

440278220 OPEN TX TRIMALLEOLAR ANKLE FX INCL FIX E

Facility

$21,060.00

Service Code	HCPCS 27822
Hospital Charge Code	440278220
Hospital Revenue Code	450
Min. Negotiated Rate	$17,901.00
Max. Negotiated Rate	$20,428.20
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Health Management Network Commercial	$17,901.00
Rate for Payer: Kaiser Permanente Commercial	$18,954.00
Rate for Payer: MDX Hawaii PPO	$20,428.20

440278290 OPEN TX DISTAL TIB/FIB DISTRUP INC FIX E

Facility

$21,060.00

Service Code	HCPCS 27829
Hospital Charge Code	440278290
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$20,428.20
Rate for Payer: AlohaCare Medicaid	$10,530.00
Rate for Payer: AlohaCare Medicare	$8,845.20
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$19,375.20
Rate for Payer: Devoted Health Medicare	$8,845.20
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	$8,845.20
Rate for Payer: Hawaii Western Management Group Commercial	$20,007.00
Rate for Payer: Health Management Network Commercial	$17,901.00
Rate for Payer: Humana Medicare	$8,845.20
Rate for Payer: Kaiser Permanente Commercial	$18,954.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$8,845.20
Rate for Payer: MDX Hawaii PPO	$20,428.20
Rate for Payer: Ohana Health Plan Medicaid	$8,845.20
Rate for Payer: Ohana Health Plan Medicare	$8,845.20
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$8,845.20
Rate for Payer: University Health Alliance Commercial	$5,160.40

440278290 OPEN TX DISTAL TIB/FIB DISTRUP INC FIX E

Facility

$21,060.00

Service Code	HCPCS 27829
Hospital Charge Code	440278290
Hospital Revenue Code	450
Min. Negotiated Rate	$17,901.00
Max. Negotiated Rate	$20,428.20
Rate for Payer: Cash Price	$13,689.00
Rate for Payer: Health Management Network Commercial	$17,901.00
Rate for Payer: Kaiser Permanente Commercial	$18,954.00
Rate for Payer: MDX Hawaii PPO	$20,428.20

Know your out-of-pocket cost for care.

All Charges