Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

26605-Metacarpal w/ Manipulation

Facility

$1,441.00

Service Code	HCPCS 26605
Hospital Charge Code	8080127
Hospital Revenue Code	450
Min. Negotiated Rate	$1,224.85
Max. Negotiated Rate	$1,397.77
Rate for Payer: Cash Price	$936.65
Rate for Payer: Health Management Network Commercial	$1,224.85
Rate for Payer: Kaiser Permanente Commercial	$1,296.90
Rate for Payer: MDX Hawaii PPO	$1,397.77

26641-Carpometacarpal Thumb

Facility

$1,031.00

Service Code	HCPCS 26641
Hospital Charge Code	8080097
Hospital Revenue Code	450
Min. Negotiated Rate	$876.35
Max. Negotiated Rate	$1,000.07
Rate for Payer: Cash Price	$670.15
Rate for Payer: Health Management Network Commercial	$876.35
Rate for Payer: Kaiser Permanente Commercial	$927.90
Rate for Payer: MDX Hawaii PPO	$1,000.07

26641-Carpometacarpal Thumb

Facility

$1,031.00

Service Code	HCPCS 26641
Hospital Charge Code	8080097
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,389.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$515.50
Rate for Payer: Cash Price	$670.15
Rate for Payer: Cash Price	$670.15
Rate for Payer: Cash Price	$670.15
Rate for Payer: Devoted Health Medicare	$567.05
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$515.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$979.45
Rate for Payer: Health Management Network Commercial	$876.35
Rate for Payer: Humana Medicare	$515.50
Rate for Payer: Kaiser Permanente Commercial	$927.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$515.50
Rate for Payer: MDX Hawaii PPO	$1,000.07
Rate for Payer: Ohana Health Plan Medicaid	$515.50
Rate for Payer: Ohana Health Plan Medicare	$515.50
Rate for Payer: UnitedHealthcare Medicare	$515.50
Rate for Payer: University Health Alliance Commercial	$751.50

26641 CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ TechFee

Facility

$1,081.00

Service Code	HCPCS 26641
Hospital Charge Code	8023062
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,389.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$540.50
Rate for Payer: Cash Price	$702.65
Rate for Payer: Cash Price	$702.65
Rate for Payer: Cash Price	$702.65
Rate for Payer: Devoted Health Medicare	$594.55
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$540.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,026.95
Rate for Payer: Health Management Network Commercial	$918.85
Rate for Payer: Humana Medicare	$540.50
Rate for Payer: Kaiser Permanente Commercial	$972.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$540.50
Rate for Payer: MDX Hawaii PPO	$1,048.57
Rate for Payer: Ohana Health Plan Medicaid	$540.50
Rate for Payer: Ohana Health Plan Medicare	$540.50
Rate for Payer: UnitedHealthcare Medicare	$540.50
Rate for Payer: University Health Alliance Commercial	$787.94

26641 CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ TechFee

Facility

$1,081.00

Service Code	HCPCS 26641
Hospital Charge Code	8023062
Hospital Revenue Code	450
Min. Negotiated Rate	$918.85
Max. Negotiated Rate	$1,048.57
Rate for Payer: Cash Price	$702.65
Rate for Payer: Health Management Network Commercial	$918.85
Rate for Payer: Kaiser Permanente Commercial	$972.90
Rate for Payer: MDX Hawaii PPO	$1,048.57

26670-Carpometacarpal Other Than Thumb

Facility

$794.00

Service Code	HCPCS 26670
Hospital Charge Code	8080099
Hospital Revenue Code	450
Min. Negotiated Rate	$674.90
Max. Negotiated Rate	$770.18
Rate for Payer: Cash Price	$516.10
Rate for Payer: Health Management Network Commercial	$674.90
Rate for Payer: Kaiser Permanente Commercial	$714.60
Rate for Payer: MDX Hawaii PPO	$770.18

26670-Carpometacarpal Other Than Thumb

Facility

$794.00

Service Code	HCPCS 26670
Hospital Charge Code	8080099
Hospital Revenue Code	450
Min. Negotiated Rate	$397.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$397.00
Rate for Payer: Cash Price	$516.10
Rate for Payer: Cash Price	$516.10
Rate for Payer: Cash Price	$516.10
Rate for Payer: Devoted Health Medicare	$436.70
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$397.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$754.30
Rate for Payer: Health Management Network Commercial	$674.90
Rate for Payer: Humana Medicare	$397.00
Rate for Payer: Kaiser Permanente Commercial	$714.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$397.00
Rate for Payer: MDX Hawaii PPO	$770.18
Rate for Payer: Ohana Health Plan Medicaid	$397.00
Rate for Payer: Ohana Health Plan Medicare	$397.00
Rate for Payer: UnitedHealthcare Medicare	$397.00
Rate for Payer: University Health Alliance Commercial	$578.75

26670 CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES TechFee

Facility

$864.00

Service Code	HCPCS 26670
Hospital Charge Code	8023066
Hospital Revenue Code	450
Min. Negotiated Rate	$734.40
Max. Negotiated Rate	$838.08
Rate for Payer: Cash Price	$561.60
Rate for Payer: Health Management Network Commercial	$734.40
Rate for Payer: Kaiser Permanente Commercial	$777.60
Rate for Payer: MDX Hawaii PPO	$838.08

26670 CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES TechFee

Facility

$864.00

Service Code	HCPCS 26670
Hospital Charge Code	8023066
Hospital Revenue Code	450
Min. Negotiated Rate	$432.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$432.00
Rate for Payer: Cash Price	$561.60
Rate for Payer: Cash Price	$561.60
Rate for Payer: Cash Price	$561.60
Rate for Payer: Devoted Health Medicare	$475.20
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$432.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$820.80
Rate for Payer: Health Management Network Commercial	$734.40
Rate for Payer: Humana Medicare	$432.00
Rate for Payer: Kaiser Permanente Commercial	$777.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$432.00
Rate for Payer: MDX Hawaii PPO	$838.08
Rate for Payer: Ohana Health Plan Medicaid	$432.00
Rate for Payer: Ohana Health Plan Medicare	$432.00
Rate for Payer: UnitedHealthcare Medicare	$432.00
Rate for Payer: University Health Alliance Commercial	$629.77

26700 CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES TechFee

Facility

$823.00

Service Code	HCPCS 26700
Hospital Charge Code	8023067
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,389.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$411.50
Rate for Payer: Cash Price	$534.95
Rate for Payer: Cash Price	$534.95
Rate for Payer: Cash Price	$534.95
Rate for Payer: Devoted Health Medicare	$452.65
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$411.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$781.85
Rate for Payer: Health Management Network Commercial	$699.55
Rate for Payer: Humana Medicare	$411.50
Rate for Payer: Kaiser Permanente Commercial	$740.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$411.50
Rate for Payer: MDX Hawaii PPO	$798.31
Rate for Payer: Ohana Health Plan Medicaid	$411.50
Rate for Payer: Ohana Health Plan Medicare	$411.50
Rate for Payer: UnitedHealthcare Medicare	$411.50
Rate for Payer: University Health Alliance Commercial	$599.88

26700 CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES TechFee

Facility

$823.00

Service Code	HCPCS 26700
Hospital Charge Code	8023067
Hospital Revenue Code	450
Min. Negotiated Rate	$699.55
Max. Negotiated Rate	$798.31
Rate for Payer: Cash Price	$534.95
Rate for Payer: Health Management Network Commercial	$699.55
Rate for Payer: Kaiser Permanente Commercial	$740.70
Rate for Payer: MDX Hawaii PPO	$798.31

26700-Metacarpophalangeal/Knuckle

Facility

$848.00

Service Code	HCPCS 26700
Hospital Charge Code	8080080
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,389.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$424.00
Rate for Payer: Cash Price	$551.20
Rate for Payer: Cash Price	$551.20
Rate for Payer: Cash Price	$551.20
Rate for Payer: Devoted Health Medicare	$466.40
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$424.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$805.60
Rate for Payer: Health Management Network Commercial	$720.80
Rate for Payer: Humana Medicare	$424.00
Rate for Payer: Kaiser Permanente Commercial	$763.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$424.00
Rate for Payer: MDX Hawaii PPO	$822.56
Rate for Payer: Ohana Health Plan Medicaid	$424.00
Rate for Payer: Ohana Health Plan Medicare	$424.00
Rate for Payer: UnitedHealthcare Medicare	$424.00
Rate for Payer: University Health Alliance Commercial	$618.11

26700-Metacarpophalangeal/Knuckle

Facility

$848.00

Service Code	HCPCS 26700
Hospital Charge Code	8080080
Hospital Revenue Code	450
Min. Negotiated Rate	$720.80
Max. Negotiated Rate	$822.56
Rate for Payer: Cash Price	$551.20
Rate for Payer: Health Management Network Commercial	$720.80
Rate for Payer: Kaiser Permanente Commercial	$763.20
Rate for Payer: MDX Hawaii PPO	$822.56

26720 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA TechFee

Facility

$843.00

Service Code	HCPCS 26720
Hospital Charge Code	8023068
Hospital Revenue Code	450
Min. Negotiated Rate	$421.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$421.50
Rate for Payer: Cash Price	$547.95
Rate for Payer: Cash Price	$547.95
Rate for Payer: Cash Price	$547.95
Rate for Payer: Devoted Health Medicare	$463.65
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$421.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$800.85
Rate for Payer: Health Management Network Commercial	$716.55
Rate for Payer: Humana Medicare	$421.50
Rate for Payer: Kaiser Permanente Commercial	$758.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$421.50
Rate for Payer: MDX Hawaii PPO	$817.71
Rate for Payer: Ohana Health Plan Medicaid	$421.50
Rate for Payer: Ohana Health Plan Medicare	$421.50
Rate for Payer: UnitedHealthcare Medicare	$421.50
Rate for Payer: University Health Alliance Commercial	$614.46

26720 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA TechFee

Facility

$843.00

Service Code	HCPCS 26720
Hospital Charge Code	8023068
Hospital Revenue Code	450
Min. Negotiated Rate	$716.55
Max. Negotiated Rate	$817.71
Rate for Payer: Cash Price	$547.95
Rate for Payer: Health Management Network Commercial	$716.55
Rate for Payer: Kaiser Permanente Commercial	$758.70
Rate for Payer: MDX Hawaii PPO	$817.71

26720-Phalanx Shaft w/o Manipulation

Facility

$773.00

Service Code	HCPCS 26720
Hospital Charge Code	8080129
Hospital Revenue Code	450
Min. Negotiated Rate	$386.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$386.50
Rate for Payer: Cash Price	$502.45
Rate for Payer: Cash Price	$502.45
Rate for Payer: Cash Price	$502.45
Rate for Payer: Devoted Health Medicare	$425.15
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$386.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$734.35
Rate for Payer: Health Management Network Commercial	$657.05
Rate for Payer: Humana Medicare	$386.50
Rate for Payer: Kaiser Permanente Commercial	$695.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$386.50
Rate for Payer: MDX Hawaii PPO	$749.81
Rate for Payer: Ohana Health Plan Medicaid	$386.50
Rate for Payer: Ohana Health Plan Medicare	$386.50
Rate for Payer: UnitedHealthcare Medicare	$386.50
Rate for Payer: University Health Alliance Commercial	$563.44

26720-Phalanx Shaft w/o Manipulation

Facility

$773.00

Service Code	HCPCS 26720
Hospital Charge Code	8080129
Hospital Revenue Code	450
Min. Negotiated Rate	$657.05
Max. Negotiated Rate	$749.81
Rate for Payer: Cash Price	$502.45
Rate for Payer: Health Management Network Commercial	$657.05
Rate for Payer: Kaiser Permanente Commercial	$695.70
Rate for Payer: MDX Hawaii PPO	$749.81

26725 Closed treatment of phalangeal shaft fracture, proximal/middle phalanx with manipulation each

Professional

Both

$1,181.00

Service Code	HCPCS 26725
Hospital Charge Code	8038000
Hospital Revenue Code	975
Min. Negotiated Rate	$170.82
Max. Negotiated Rate	$1,003.85
Rate for Payer: AlohaCare Medicaid	$333.73
Rate for Payer: AlohaCare Medicare	$337.17
Rate for Payer: Cash Price	$767.65
Rate for Payer: Cash Price	$767.65
Rate for Payer: Devoted Health Medicare	$370.89
Rate for Payer: Hawaii Medical Service Association ABD	$333.73
Rate for Payer: Hawaii Medical Service Association Medicare	$337.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$333.73
Rate for Payer: Hawaii Western Management Group Commercial	$170.82
Rate for Payer: Health Management Network Commercial	$1,003.85
Rate for Payer: Kaiser Permanente Commercial	$370.89
Rate for Payer: Kaiser Permanente Medicaid	$370.89
Rate for Payer: Kaiser Permanente Medicare	$370.89
Rate for Payer: Ohana Health Plan Medicaid	$333.73
Rate for Payer: Ohana Health Plan Medicare	$337.17
Rate for Payer: UnitedHealthcare Medicaid	$333.73
Rate for Payer: UnitedHealthcare Medicare	$337.17
Rate for Payer: University Health Alliance Commercial	$426.02

26725-Phalanx Shaft w/ Manipulation

Facility

$1,441.00

Service Code	HCPCS 26725
Hospital Charge Code	8080131
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$720.50
Rate for Payer: Cash Price	$936.65
Rate for Payer: Cash Price	$936.65
Rate for Payer: Cash Price	$936.65
Rate for Payer: Devoted Health Medicare	$792.55
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$720.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,368.95
Rate for Payer: Health Management Network Commercial	$1,224.85
Rate for Payer: Humana Medicare	$720.50
Rate for Payer: Kaiser Permanente Commercial	$1,296.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$720.50
Rate for Payer: MDX Hawaii PPO	$1,397.77
Rate for Payer: Ohana Health Plan Medicaid	$720.50
Rate for Payer: Ohana Health Plan Medicare	$720.50
Rate for Payer: UnitedHealthcare Medicare	$720.50
Rate for Payer: University Health Alliance Commercial	$1,050.34

26725-Phalanx Shaft w/ Manipulation

Facility

$1,441.00

Service Code	HCPCS 26725
Hospital Charge Code	8080131
Hospital Revenue Code	450
Min. Negotiated Rate	$1,224.85
Max. Negotiated Rate	$1,397.77
Rate for Payer: Cash Price	$936.65
Rate for Payer: Health Management Network Commercial	$1,224.85
Rate for Payer: Kaiser Permanente Commercial	$1,296.90
Rate for Payer: MDX Hawaii PPO	$1,397.77

26742-Metacarpophalangeal/Interphalangeal Joint w/ Manip

Facility

$7,364.00

Service Code	HCPCS 26742
Hospital Charge Code	8080133
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$7,143.08
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$3,682.00
Rate for Payer: Cash Price	$4,786.60
Rate for Payer: Cash Price	$4,786.60
Rate for Payer: Cash Price	$4,786.60
Rate for Payer: Devoted Health Medicare	$4,050.20
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,682.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,995.80
Rate for Payer: Health Management Network Commercial	$6,259.40
Rate for Payer: Humana Medicare	$3,682.00
Rate for Payer: Kaiser Permanente Commercial	$6,627.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,682.00
Rate for Payer: MDX Hawaii PPO	$7,143.08
Rate for Payer: Ohana Health Plan Medicaid	$3,682.00
Rate for Payer: Ohana Health Plan Medicare	$3,682.00
Rate for Payer: UnitedHealthcare Medicare	$3,682.00
Rate for Payer: University Health Alliance Commercial	$5,367.62

26742-Metacarpophalangeal/Interphalangeal Joint w/ Manip

Facility

$7,364.00

Service Code	HCPCS 26742
Hospital Charge Code	8080133
Hospital Revenue Code	450
Min. Negotiated Rate	$6,259.40
Max. Negotiated Rate	$7,143.08
Rate for Payer: Cash Price	$4,786.60
Rate for Payer: Health Management Network Commercial	$6,259.40
Rate for Payer: Kaiser Permanente Commercial	$6,627.60
Rate for Payer: MDX Hawaii PPO	$7,143.08

26750 CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA TechFee

Facility

$843.00

Service Code	HCPCS 26750
Hospital Charge Code	8023074
Hospital Revenue Code	450
Min. Negotiated Rate	$421.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$421.50
Rate for Payer: Cash Price	$547.95
Rate for Payer: Cash Price	$547.95
Rate for Payer: Cash Price	$547.95
Rate for Payer: Devoted Health Medicare	$463.65
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$421.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$800.85
Rate for Payer: Health Management Network Commercial	$716.55
Rate for Payer: Humana Medicare	$421.50
Rate for Payer: Kaiser Permanente Commercial	$758.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$421.50
Rate for Payer: MDX Hawaii PPO	$817.71
Rate for Payer: Ohana Health Plan Medicaid	$421.50
Rate for Payer: Ohana Health Plan Medicare	$421.50
Rate for Payer: UnitedHealthcare Medicare	$421.50
Rate for Payer: University Health Alliance Commercial	$614.46

26750 CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA TechFee

Facility

$843.00

Service Code	HCPCS 26750
Hospital Charge Code	8023074
Hospital Revenue Code	450
Min. Negotiated Rate	$716.55
Max. Negotiated Rate	$817.71
Rate for Payer: Cash Price	$547.95
Rate for Payer: Health Management Network Commercial	$716.55
Rate for Payer: Kaiser Permanente Commercial	$758.70
Rate for Payer: MDX Hawaii PPO	$817.71

26755-Distal Phalangeal w/ Manipulation

Facility

$1,441.00

Service Code	HCPCS 26755
Hospital Charge Code	8080102
Hospital Revenue Code	450
Min. Negotiated Rate	$1,224.85
Max. Negotiated Rate	$1,397.77
Rate for Payer: Cash Price	$936.65
Rate for Payer: Health Management Network Commercial	$1,224.85
Rate for Payer: Kaiser Permanente Commercial	$1,296.90
Rate for Payer: MDX Hawaii PPO	$1,397.77

Know your out-of-pocket cost for care.

All Charges