Kau Hospital

All Charges

Charge

Type

Setting

Price

HC CLOSED RX CONDYLAR FX

Facility

$935.00

Service Code	HCPCS 27501
Hospital Charge Code	7612750101
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 CONDYLAR FX

Facility

$935.00

Service Code	HCPCS 27501
Hospital Charge Code	7612750101
Hospital Revenue Code	450
Min. Negotiated Rate	$289.85
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$467.50
Rate for Payer: AlohaCare Medicare	$289.85
Rate for Payer: Cash Price	$561.00
Rate for Payer: Cash Price	$561.00
Rate for Payer: Devoted Health Medicare	$317.90
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	$289.85
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	$289.85
Rate for Payer: Kaiser Permanente Commercial	$841.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$289.85
Rate for Payer: MDX Hawaii PPO	$906.95
Rate for Payer: Ohana Health Plan Medicaid	$289.85
Rate for Payer: Ohana Health Plan Medicare	$289.85
Rate for Payer: UnitedHealthcare Medicare	$289.85
Rate for Payer: University Health Alliance Commercial	$681.52

HC CLOSED RX DENTAL RIDGE FX

Facility

$12,637.00

Service Code	HCPCS 21440
Hospital Charge Code	7612144001
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 DENTAL RIDGE FX

Facility

$12,637.00

Service Code	HCPCS 21440
Hospital Charge Code	7612144001
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	$3,917.47
Rate for Payer: Cash Price	$7,582.20
Rate for Payer: Cash Price	$7,582.20
Rate for Payer: Devoted Health Medicare	$4,296.58
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	$3,917.47
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	$3,917.47
Rate for Payer: Kaiser Permanente Commercial	$11,373.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,917.47
Rate for Payer: MDX Hawaii PPO	$12,257.89
Rate for Payer: Ohana Health Plan Medicaid	$3,917.47
Rate for Payer: Ohana Health Plan Medicare	$3,917.47
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,917.47
Rate for Payer: University Health Alliance Commercial	$9,211.11

HC CLOSED RX DIST FEM EPIPHYSIS+MANIP

Facility

$6,236.00

Service Code	HCPCS 27517
Hospital Charge Code	7612751701
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	$1,933.16
Rate for Payer: Cash Price	$3,741.60
Rate for Payer: Cash Price	$3,741.60
Rate for Payer: Devoted Health Medicare	$2,120.24
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	$1,933.16
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	$1,933.16
Rate for Payer: Kaiser Permanente Commercial	$5,612.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,933.16
Rate for Payer: MDX Hawaii PPO	$6,048.92
Rate for Payer: Ohana Health Plan Medicaid	$1,933.16
Rate for Payer: Ohana Health Plan Medicare	$1,933.16
Rate for Payer: UnitedHealthcare Medicare	$1,933.16
Rate for Payer: University Health Alliance Commercial	$4,545.42

HC CLOSED RX DIST FEM EPIPHYSIS+MANIP

Facility

$6,236.00

Service Code	HCPCS 27517
Hospital Charge Code	7612751701
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 DIST FIBULA FX

Facility

$955.00

Service Code	HCPCS 27786
Hospital Charge Code	7612778601
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 DIST FIBULA FX

Facility

$955.00

Service Code	HCPCS 27786
Hospital Charge Code	7612778601
Hospital Revenue Code	450
Min. Negotiated Rate	$296.05
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$477.50
Rate for Payer: AlohaCare Medicare	$296.05
Rate for Payer: Cash Price	$573.00
Rate for Payer: Cash Price	$573.00
Rate for Payer: Devoted Health Medicare	$324.70
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	$296.05
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	$296.05
Rate for Payer: Kaiser Permanente Commercial	$859.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$296.05
Rate for Payer: MDX Hawaii PPO	$926.35
Rate for Payer: Ohana Health Plan Medicaid	$296.05
Rate for Payer: Ohana Health Plan Medicare	$296.05
Rate for Payer: UnitedHealthcare Medicare	$296.05
Rate for Payer: University Health Alliance Commercial	$696.10

HC CLOSED RX DIST RAD/ULNA FX,MANIPUL

Facility

$6,369.00

Service Code	HCPCS 25605
Hospital Charge Code	4502560501
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	$1,974.39
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Devoted Health Medicare	$2,165.46
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	$1,974.39
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	$1,974.39
Rate for Payer: Kaiser Permanente Commercial	$5,732.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,974.39
Rate for Payer: MDX Hawaii PPO	$6,177.93
Rate for Payer: Ohana Health Plan Medicaid	$1,974.39
Rate for Payer: Ohana Health Plan Medicare	$1,974.39
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,974.39
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC CLOSED RX DIST RAD/ULNA FX,MANIPUL

Facility

$6,369.00

Service Code	HCPCS 25605
Hospital Charge Code	4502560501
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 ELBOW DISLOCATN,ANESTHESIA

Facility

$6,369.00

Service Code	HCPCS 24605
Hospital Charge Code	7612460501
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	$1,974.39
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Devoted Health Medicare	$2,165.46
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	$1,974.39
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	$1,974.39
Rate for Payer: Kaiser Permanente Commercial	$5,732.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,974.39
Rate for Payer: MDX Hawaii PPO	$6,177.93
Rate for Payer: Ohana Health Plan Medicaid	$1,974.39
Rate for Payer: Ohana Health Plan Medicare	$1,974.39
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,974.39
Rate for Payer: University Health Alliance Commercial	$5,160.40

HC CLOSED RX ELBOW DISLOCATN,ANESTHESIA

Facility

$6,369.00

Service Code	HCPCS 24605
Hospital Charge Code	7612460501
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 FEMUR,DISTAL+MANIP

Facility

$6,236.00

Service Code	HCPCS 27510
Hospital Charge Code	7612751001
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 FEMUR,DISTAL+MANIP

Facility

$6,236.00

Service Code	HCPCS 27510
Hospital Charge Code	7612751001
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	$1,933.16
Rate for Payer: Cash Price	$3,741.60
Rate for Payer: Cash Price	$3,741.60
Rate for Payer: Devoted Health Medicare	$2,120.24
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	$1,933.16
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	$1,933.16
Rate for Payer: Kaiser Permanente Commercial	$5,612.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,933.16
Rate for Payer: MDX Hawaii PPO	$6,048.92
Rate for Payer: Ohana Health Plan Medicaid	$1,933.16
Rate for Payer: Ohana Health Plan Medicare	$1,933.16
Rate for Payer: UnitedHealthcare Medicare	$1,933.16
Rate for Payer: University Health Alliance Commercial	$4,545.42

HC CLOSED RX FEMUR SHAFT FX+MANIP

Facility

$6,369.00

Service Code	HCPCS 27502
Hospital Charge Code	7612750201
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 FEMUR SHAFT FX+MANIP

Facility

$6,369.00

Service Code	HCPCS 27502
Hospital Charge Code	7612750201
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	$1,974.39
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Devoted Health Medicare	$2,165.46
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	$1,974.39
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	$1,974.39
Rate for Payer: Kaiser Permanente Commercial	$5,732.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,974.39
Rate for Payer: MDX Hawaii PPO	$6,177.93
Rate for Payer: Ohana Health Plan Medicaid	$1,974.39
Rate for Payer: Ohana Health Plan Medicare	$1,974.39
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,974.39
Rate for Payer: University Health Alliance Commercial	$4,642.36

HC CLOSED RX GR TUBEROSITY HUM FX

Facility

$935.00

Service Code	HCPCS 23620
Hospital Charge Code	7612362001
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 GR TUBEROSITY HUM FX

Facility

$935.00

Service Code	HCPCS 23620
Hospital Charge Code	7612362001
Hospital Revenue Code	450
Min. Negotiated Rate	$289.85
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$467.50
Rate for Payer: AlohaCare Medicare	$289.85
Rate for Payer: Cash Price	$561.00
Rate for Payer: Cash Price	$561.00
Rate for Payer: Devoted Health Medicare	$317.90
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	$289.85
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	$289.85
Rate for Payer: Kaiser Permanente Commercial	$841.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$289.85
Rate for Payer: MDX Hawaii PPO	$906.95
Rate for Payer: Ohana Health Plan Medicaid	$289.85
Rate for Payer: Ohana Health Plan Medicare	$289.85
Rate for Payer: UnitedHealthcare Medicare	$289.85
Rate for Payer: University Health Alliance Commercial	$681.52

HC CLOSED RX HUMERAL SUPRACONDYLAR FX

Facility

$935.00

Service Code	HCPCS 24530
Hospital Charge Code	7612453001
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 HUMERAL SUPRACONDYLAR FX

Facility

$935.00

Service Code	HCPCS 24530
Hospital Charge Code	7612453001
Hospital Revenue Code	450
Min. Negotiated Rate	$289.85
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$467.50
Rate for Payer: AlohaCare Medicare	$289.85
Rate for Payer: Cash Price	$561.00
Rate for Payer: Cash Price	$561.00
Rate for Payer: Devoted Health Medicare	$317.90
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	$289.85
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	$289.85
Rate for Payer: Kaiser Permanente Commercial	$841.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$289.85
Rate for Payer: MDX Hawaii PPO	$906.95
Rate for Payer: Ohana Health Plan Medicaid	$289.85
Rate for Payer: Ohana Health Plan Medicare	$289.85
Rate for Payer: UnitedHealthcare Medicare	$289.85
Rate for Payer: University Health Alliance Commercial	$681.52

HC CLOSED RX HUMER CONDYLR FX,MANIP

Facility

$6,369.00

Service Code	HCPCS 24577
Hospital Charge Code	7612457701
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	$1,974.39
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Devoted Health Medicare	$2,165.46
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	$1,974.39
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	$1,974.39
Rate for Payer: Kaiser Permanente Commercial	$5,732.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,974.39
Rate for Payer: MDX Hawaii PPO	$6,177.93
Rate for Payer: Ohana Health Plan Medicaid	$1,974.39
Rate for Payer: Ohana Health Plan Medicare	$1,974.39
Rate for Payer: UnitedHealthcare Medicare	$1,974.39
Rate for Payer: University Health Alliance Commercial	$4,642.36

HC CLOSED RX HUMER CONDYLR FX,MANIP

Facility

$6,369.00

Service Code	HCPCS 24577
Hospital Charge Code	7612457701
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 HUMER EPICONDYLR FX,MANIP

Facility

$6,369.00

Service Code	HCPCS 24565
Hospital Charge Code	7612456501
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	$1,974.39
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Devoted Health Medicare	$2,165.46
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	$1,974.39
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	$1,974.39
Rate for Payer: Kaiser Permanente Commercial	$5,732.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,974.39
Rate for Payer: MDX Hawaii PPO	$6,177.93
Rate for Payer: Ohana Health Plan Medicaid	$1,974.39
Rate for Payer: Ohana Health Plan Medicare	$1,974.39
Rate for Payer: UnitedHealthcare Medicare	$1,974.39
Rate for Payer: University Health Alliance Commercial	$4,642.36

HC CLOSED RX HUMER EPICONDYLR FX,MANIP

Facility

$6,369.00

Service Code	HCPCS 24565
Hospital Charge Code	7612456501
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 HUM SUPRACONDYLR FX,MANIPU

Facility

$6,369.00

Service Code	HCPCS 24535
Hospital Charge Code	7612453501
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	$1,974.39
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Cash Price	$3,821.40
Rate for Payer: Devoted Health Medicare	$2,165.46
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	$1,974.39
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	$1,974.39
Rate for Payer: Kaiser Permanente Commercial	$5,732.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,974.39
Rate for Payer: MDX Hawaii PPO	$6,177.93
Rate for Payer: Ohana Health Plan Medicaid	$1,974.39
Rate for Payer: Ohana Health Plan Medicare	$1,974.39
Rate for Payer: UnitedHealthcare Medicare	$1,974.39
Rate for Payer: University Health Alliance Commercial	$4,642.36

Know your out-of-pocket cost for care.

All Charges