Kau Hospital

All Charges

Charge

Type

Setting

Price

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	$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 KNEECAP DISLOCATN

Facility

$955.00

Service Code	HCPCS 27560
Hospital Charge Code	4502756001
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 KNEECAP DISLOCATN

Facility

$955.00

Service Code	HCPCS 27560
Hospital Charge Code	4502756001
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 KNEE DISLOC+ANESTH

Facility

$6,369.00

Service Code	HCPCS 27552
Hospital Charge Code	7612755201
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	$4,035.20

HC CLOSED RX KNEE DISLOC+ANESTH

Facility

$6,369.00

Service Code	HCPCS 27552
Hospital Charge Code	7612755201
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 KNEE DISLOCATN

Facility

$955.00

Service Code	HCPCS 27550
Hospital Charge Code	7612755001
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 KNEE DISLOCATN

Facility

$955.00

Service Code	HCPCS 27550
Hospital Charge Code	7612755001
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 MANDIBLE FX+MANIPULATN

Facility

$5,772.00

Service Code	HCPCS 21451
Hospital Charge Code	7612145101
Hospital Revenue Code	450
Min. Negotiated Rate	$4,906.20
Max. Negotiated Rate	$5,598.84
Rate for Payer: Cash Price	$3,463.20
Rate for Payer: Health Management Network Commercial	$4,906.20
Rate for Payer: Kaiser Permanente Commercial	$5,194.80
Rate for Payer: MDX Hawaii PPO	$5,598.84

HC CLOSED RX MANDIBLE FX+MANIPULATN

Facility

$5,772.00

Service Code	HCPCS 21451
Hospital Charge Code	7612145101
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$5,598.84
Rate for Payer: AlohaCare Medicaid	$2,886.00
Rate for Payer: AlohaCare Medicare	$1,789.32
Rate for Payer: Cash Price	$3,463.20
Rate for Payer: Cash Price	$3,463.20
Rate for Payer: Devoted Health Medicare	$1,962.48
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	$1,789.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,483.40
Rate for Payer: Health Management Network Commercial	$4,906.20
Rate for Payer: Humana Medicare	$1,789.32
Rate for Payer: Kaiser Permanente Commercial	$5,194.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,789.32
Rate for Payer: MDX Hawaii PPO	$5,598.84
Rate for Payer: Ohana Health Plan Medicaid	$1,789.32
Rate for Payer: Ohana Health Plan Medicare	$1,789.32
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,789.32
Rate for Payer: University Health Alliance Commercial	$4,207.21

HC CLOSED RX MED MALLEOLUS FX

Facility

$955.00

Service Code	HCPCS 27760
Hospital Charge Code	7612776001
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 MED MALLEOLUS FX

Facility

$955.00

Service Code	HCPCS 27760
Hospital Charge Code	7612776001
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 MED MALLEOLUS FX,MANIP

Facility

$6,369.00

Service Code	HCPCS 27762
Hospital Charge Code	7612776201
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 MED MALLEOLUS FX,MANIP

Facility

$6,369.00

Service Code	HCPCS 27762
Hospital Charge Code	7612776201
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 METACARPAL FX

Facility

$955.00

Service Code	HCPCS 26600
Hospital Charge Code	7612660001
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 METACARPAL FX

Facility

$955.00

Service Code	HCPCS 26600
Hospital Charge Code	7612660001
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 MID HUMERUS FX,MANIPULATN

Facility

$6,369.00

Service Code	HCPCS 24505
Hospital Charge Code	7612450501
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 MID HUMERUS FX,MANIPULATN

Facility

$6,369.00

Service Code	HCPCS 24505
Hospital Charge Code	7612450501
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 MONTEGGIA FX/DISLOC ELBOW

Facility

$6,369.00

Service Code	HCPCS 24620
Hospital Charge Code	7612462001
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	$4,035.20

HC CLOSED RX MONTEGGIA FX/DISLOC ELBOW

Facility

$6,369.00

Service Code	HCPCS 24620
Hospital Charge Code	7612462001
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 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 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	$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	$5,160.40

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	$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 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/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 PROX/NECK FEMUR FX

Facility

$935.00

Service Code	HCPCS 27230
Hospital Charge Code	7612723001
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

Know your out-of-pocket cost for care.

All Charges