Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

CLOSED TREATMENT OF PATELLAR FRACTURE WITHOUT MANI

Facility

$887.00

Service Code	HCPCS 27520
Hospital Charge Code	440275200
Hospital Revenue Code	450
Min. Negotiated Rate	$753.95
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$576.55
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39

CLOSED TREATMENT OF PELVIC RING FRACTURE, DISLOCAT

Facility

$887.00

Service Code	HCPCS 27193
Hospital Charge Code	440271930
Hospital Revenue Code	450
Min. Negotiated Rate	$372.54
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$443.50
Rate for Payer: AlohaCare Medicare	$372.54
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$816.04
Rate for Payer: Devoted Health Medicare	$372.54
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	$372.54
Rate for Payer: Hawaii Western Management Group Commercial	$842.65
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Humana Medicare	$372.54
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$372.54
Rate for Payer: MDX Hawaii PPO	$860.39
Rate for Payer: Ohana Health Plan Medicaid	$372.54
Rate for Payer: Ohana Health Plan Medicare	$372.54
Rate for Payer: UnitedHealthcare Medicare	$372.54
Rate for Payer: University Health Alliance Commercial	$646.53

CLOSED TREATMENT OF PELVIC RING FRACTURE, DISLOCAT

Facility

$887.00

Service Code	HCPCS 27193
Hospital Charge Code	440271930
Hospital Revenue Code	450
Min. Negotiated Rate	$753.95
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$576.55
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39

CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCAT

Facility

$887.00

Service Code	HCPCS 27265
Hospital Charge Code	440272650
Hospital Revenue Code	450
Min. Negotiated Rate	$372.54
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$443.50
Rate for Payer: AlohaCare Medicare	$372.54
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$816.04
Rate for Payer: Devoted Health Medicare	$372.54
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	$372.54
Rate for Payer: Hawaii Western Management Group Commercial	$842.65
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Humana Medicare	$372.54
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$372.54
Rate for Payer: MDX Hawaii PPO	$860.39
Rate for Payer: Ohana Health Plan Medicaid	$372.54
Rate for Payer: Ohana Health Plan Medicare	$372.54
Rate for Payer: UnitedHealthcare Medicare	$372.54
Rate for Payer: University Health Alliance Commercial	$646.53

CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCAT

Facility

$887.00

Service Code	HCPCS 27265
Hospital Charge Code	440272650
Hospital Revenue Code	450
Min. Negotiated Rate	$753.95
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$576.55
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39

CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACT

Facility

$2,294.00

Service Code	HCPCS 27781
Hospital Charge Code	440277810
Hospital Revenue Code	450
Min. Negotiated Rate	$1,949.90
Max. Negotiated Rate	$2,225.18
Rate for Payer: Cash Price	$1,491.10
Rate for Payer: Health Management Network Commercial	$1,949.90
Rate for Payer: Kaiser Permanente Commercial	$2,064.60
Rate for Payer: MDX Hawaii PPO	$2,225.18

CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACT

Facility

$2,294.00

Service Code	HCPCS 27781
Hospital Charge Code	440277810
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,225.18
Rate for Payer: AlohaCare Medicaid	$1,147.00
Rate for Payer: AlohaCare Medicare	$963.48
Rate for Payer: Cash Price	$1,491.10
Rate for Payer: Cash Price	$1,491.10
Rate for Payer: Cash Price	$1,491.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2,110.48
Rate for Payer: Devoted Health Medicare	$963.48
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	$963.48
Rate for Payer: Hawaii Western Management Group Commercial	$2,179.30
Rate for Payer: Health Management Network Commercial	$1,949.90
Rate for Payer: Humana Medicare	$963.48
Rate for Payer: Kaiser Permanente Commercial	$2,064.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$963.48
Rate for Payer: MDX Hawaii PPO	$2,225.18
Rate for Payer: Ohana Health Plan Medicaid	$963.48
Rate for Payer: Ohana Health Plan Medicare	$963.48
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$963.48
Rate for Payer: University Health Alliance Commercial	$1,672.10

CLOSED TREATMENT OF PROXIMAL HUMERAL FRACTURE WITH

Facility

$6,394.00

Service Code	HCPCS 23605
Hospital Charge Code	440236050
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

CLOSED TREATMENT OF PROXIMAL HUMERAL FRACTURE WITH

Facility

$6,394.00

Service Code	HCPCS 23605
Hospital Charge Code	440236050
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	$4,660.59

Closed treatment of proximal tibiofibular joint di

Facility

$554.00

Service Code	HCPCS 27830
Hospital Charge Code	440278300
Hospital Revenue Code	450
Min. Negotiated Rate	$470.90
Max. Negotiated Rate	$537.38
Rate for Payer: Cash Price	$360.10
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: MDX Hawaii PPO	$537.38

Closed treatment of proximal tibiofibular joint di

Facility

$554.00

Service Code	HCPCS 27830
Hospital Charge Code	440278300
Hospital Revenue Code	450
Min. Negotiated Rate	$232.68
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$277.00
Rate for Payer: AlohaCare Medicare	$232.68
Rate for Payer: Cash Price	$360.10
Rate for Payer: Cash Price	$360.10
Rate for Payer: Cash Price	$360.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$509.68
Rate for Payer: Devoted Health Medicare	$232.68
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	$232.68
Rate for Payer: Hawaii Western Management Group Commercial	$526.30
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Humana Medicare	$232.68
Rate for Payer: Kaiser Permanente Commercial	$498.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$232.68
Rate for Payer: MDX Hawaii PPO	$537.38
Rate for Payer: Ohana Health Plan Medicaid	$232.68
Rate for Payer: Ohana Health Plan Medicare	$232.68
Rate for Payer: UnitedHealthcare Medicare	$232.68
Rate for Payer: University Health Alliance Commercial	$403.81

CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE W

Facility

$887.00

Service Code	HCPCS 24655
Hospital Charge Code	440246550
Hospital Revenue Code	450
Min. Negotiated Rate	$372.54
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$443.50
Rate for Payer: AlohaCare Medicare	$372.54
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$816.04
Rate for Payer: Devoted Health Medicare	$372.54
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	$372.54
Rate for Payer: Hawaii Western Management Group Commercial	$842.65
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Humana Medicare	$372.54
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$372.54
Rate for Payer: MDX Hawaii PPO	$860.39
Rate for Payer: Ohana Health Plan Medicaid	$372.54
Rate for Payer: Ohana Health Plan Medicare	$372.54
Rate for Payer: UnitedHealthcare Medicare	$372.54
Rate for Payer: University Health Alliance Commercial	$646.53

CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE W

Facility

$887.00

Service Code	HCPCS 24655
Hospital Charge Code	440246550
Hospital Revenue Code	450
Min. Negotiated Rate	$753.95
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$576.55
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39

CLOSED TREATMENT OF RADIAL SHAFT FRACTURE AND DISL

Facility

$887.00

Service Code	HCPCS 25520
Hospital Charge Code	440255200
Hospital Revenue Code	450
Min. Negotiated Rate	$372.54
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$443.50
Rate for Payer: AlohaCare Medicare	$372.54
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$816.04
Rate for Payer: Devoted Health Medicare	$372.54
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	$372.54
Rate for Payer: Hawaii Western Management Group Commercial	$842.65
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Humana Medicare	$372.54
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$372.54
Rate for Payer: MDX Hawaii PPO	$860.39
Rate for Payer: Ohana Health Plan Medicaid	$372.54
Rate for Payer: Ohana Health Plan Medicare	$372.54
Rate for Payer: UnitedHealthcare Medicare	$372.54
Rate for Payer: University Health Alliance Commercial	$646.53

CLOSED TREATMENT OF RADIAL SHAFT FRACTURE AND DISL

Facility

$887.00

Service Code	HCPCS 25520
Hospital Charge Code	440255200
Hospital Revenue Code	450
Min. Negotiated Rate	$753.95
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$576.55
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39

CLOSED TREATMENT OF SHOULDER DISLOCATION WITH FRAC

Facility

$2,294.00

Service Code	HCPCS 23665
Hospital Charge Code	440236650
Hospital Revenue Code	450
Min. Negotiated Rate	$1,949.90
Max. Negotiated Rate	$2,225.18
Rate for Payer: Cash Price	$1,491.10
Rate for Payer: Health Management Network Commercial	$1,949.90
Rate for Payer: Kaiser Permanente Commercial	$2,064.60
Rate for Payer: MDX Hawaii PPO	$2,225.18

CLOSED TREATMENT OF SHOULDER DISLOCATION WITH FRAC

Facility

$2,294.00

Service Code	HCPCS 23665
Hospital Charge Code	440236650
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,225.18
Rate for Payer: AlohaCare Medicaid	$1,147.00
Rate for Payer: AlohaCare Medicare	$963.48
Rate for Payer: Cash Price	$1,491.10
Rate for Payer: Cash Price	$1,491.10
Rate for Payer: Cash Price	$1,491.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2,110.48
Rate for Payer: Devoted Health Medicare	$963.48
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	$963.48
Rate for Payer: Hawaii Western Management Group Commercial	$2,179.30
Rate for Payer: Health Management Network Commercial	$1,949.90
Rate for Payer: Humana Medicare	$963.48
Rate for Payer: Kaiser Permanente Commercial	$2,064.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$963.48
Rate for Payer: MDX Hawaii PPO	$2,225.18
Rate for Payer: Ohana Health Plan Medicaid	$963.48
Rate for Payer: Ohana Health Plan Medicare	$963.48
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$963.48
Rate for Payer: University Health Alliance Commercial	$1,672.10

CLOSED TREATMENT OF SHOULDER DISLOCATION WITH SURG

Facility

$887.00

Service Code	HCPCS 23675
Hospital Charge Code	440236750
Hospital Revenue Code	450
Min. Negotiated Rate	$372.54
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$443.50
Rate for Payer: AlohaCare Medicare	$372.54
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$816.04
Rate for Payer: Devoted Health Medicare	$372.54
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	$372.54
Rate for Payer: Hawaii Western Management Group Commercial	$842.65
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Humana Medicare	$372.54
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$372.54
Rate for Payer: MDX Hawaii PPO	$860.39
Rate for Payer: Ohana Health Plan Medicaid	$372.54
Rate for Payer: Ohana Health Plan Medicare	$372.54
Rate for Payer: UnitedHealthcare Medicare	$372.54
Rate for Payer: University Health Alliance Commercial	$646.53

CLOSED TREATMENT OF SHOULDER DISLOCATION WITH SURG

Facility

$887.00

Service Code	HCPCS 23675
Hospital Charge Code	440236750
Hospital Revenue Code	450
Min. Negotiated Rate	$753.95
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$576.55
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39

CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION W

Facility

$6,394.00

Service Code	HCPCS 23520
Hospital Charge Code	440235200
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

CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION W

Facility

$6,394.00

Service Code	HCPCS 23520
Hospital Charge Code	440235200
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	$4,660.59

CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR

Facility

$887.00

Service Code	HCPCS 27503
Hospital Charge Code	440275030
Hospital Revenue Code	450
Min. Negotiated Rate	$372.54
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$443.50
Rate for Payer: AlohaCare Medicare	$372.54
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$816.04
Rate for Payer: Devoted Health Medicare	$372.54
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	$372.54
Rate for Payer: Hawaii Western Management Group Commercial	$842.65
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Humana Medicare	$372.54
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$372.54
Rate for Payer: MDX Hawaii PPO	$860.39
Rate for Payer: Ohana Health Plan Medicaid	$372.54
Rate for Payer: Ohana Health Plan Medicare	$372.54
Rate for Payer: UnitedHealthcare Medicare	$372.54
Rate for Payer: University Health Alliance Commercial	$646.53

CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR

Facility

$887.00

Service Code	HCPCS 24530
Hospital Charge Code	440245300
Hospital Revenue Code	450
Min. Negotiated Rate	$753.95
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$576.55
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39

CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR

Facility

$887.00

Service Code	HCPCS 27501
Hospital Charge Code	440275010
Hospital Revenue Code	450
Min. Negotiated Rate	$753.95
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$576.55
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39

CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLAR

Facility

$887.00

Service Code	HCPCS 27503
Hospital Charge Code	440275030
Hospital Revenue Code	450
Min. Negotiated Rate	$753.95
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$576.55
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39

Know your out-of-pocket cost for care.

All Charges