Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

27780 CLTX PROX FIBULA/SHFT FX W/O MANJ TechFee

Facility

$843.00

Service Code	HCPCS 27780
Hospital Charge Code	8023202
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

27780 CLTX PROX FIBULA/SHFT FX W/O MANJ TechFee

Facility

$843.00

Service Code	HCPCS 27780
Hospital Charge Code	8023202
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	$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	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$421.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
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

27786 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ TechFee

Facility

$843.00

Service Code	HCPCS 27786
Hospital Charge Code	8023205
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	$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	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$421.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
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

27786 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ TechFee

Facility

$843.00

Service Code	HCPCS 27786
Hospital Charge Code	8023205
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

27786-Distal Fibular w/o Manipulation

Facility

$773.00

Service Code	HCPCS 27786
Hospital Charge Code	8080116
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

27786-Distal Fibular w/o Manipulation

Facility

$773.00

Service Code	HCPCS 27786
Hospital Charge Code	8080116
Hospital Revenue Code	450
Min. Negotiated Rate	$386.50
Max. Negotiated Rate	$2,389.00
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	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$386.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
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

27788-Distal Fibular w/ Manipulation

Facility

$1,434.00

Service Code	HCPCS 27788
Hospital Charge Code	8080118
Hospital Revenue Code	450
Min. Negotiated Rate	$1,218.90
Max. Negotiated Rate	$1,390.98
Rate for Payer: Cash Price	$932.10
Rate for Payer: Health Management Network Commercial	$1,218.90
Rate for Payer: Kaiser Permanente Commercial	$1,290.60
Rate for Payer: MDX Hawaii PPO	$1,390.98

27788-Distal Fibular w/ Manipulation

Facility

$1,434.00

Service Code	HCPCS 27788
Hospital Charge Code	8080118
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	$717.00
Rate for Payer: Cash Price	$932.10
Rate for Payer: Cash Price	$932.10
Rate for Payer: Cash Price	$932.10
Rate for Payer: Devoted Health Medicare	$788.70
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	$717.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,362.30
Rate for Payer: Health Management Network Commercial	$1,218.90
Rate for Payer: Humana Medicare	$717.00
Rate for Payer: Kaiser Permanente Commercial	$1,290.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$717.00
Rate for Payer: MDX Hawaii PPO	$1,390.98
Rate for Payer: Ohana Health Plan Medicaid	$717.00
Rate for Payer: Ohana Health Plan Medicare	$717.00
Rate for Payer: UnitedHealthcare Medicare	$717.00
Rate for Payer: University Health Alliance Commercial	$1,045.24

27808-Bimalleolar Ankle w/o Manipulation

Facility

$1,434.00

Service Code	HCPCS 27808
Hospital Charge Code	8080120
Hospital Revenue Code	450
Min. Negotiated Rate	$1,218.90
Max. Negotiated Rate	$1,390.98
Rate for Payer: Cash Price	$932.10
Rate for Payer: Health Management Network Commercial	$1,218.90
Rate for Payer: Kaiser Permanente Commercial	$1,290.60
Rate for Payer: MDX Hawaii PPO	$1,390.98

27808-Bimalleolar Ankle w/o Manipulation

Facility

$1,434.00

Service Code	HCPCS 27808
Hospital Charge Code	8080120
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	$717.00
Rate for Payer: Cash Price	$932.10
Rate for Payer: Cash Price	$932.10
Rate for Payer: Cash Price	$932.10
Rate for Payer: Devoted Health Medicare	$788.70
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	$717.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,362.30
Rate for Payer: Health Management Network Commercial	$1,218.90
Rate for Payer: Humana Medicare	$717.00
Rate for Payer: Kaiser Permanente Commercial	$1,290.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$717.00
Rate for Payer: MDX Hawaii PPO	$1,390.98
Rate for Payer: Ohana Health Plan Medicaid	$717.00
Rate for Payer: Ohana Health Plan Medicare	$717.00
Rate for Payer: UnitedHealthcare Medicare	$717.00
Rate for Payer: University Health Alliance Commercial	$1,045.24

27810-Bimalleolar Ankle w/ Manipulation

Facility

$7,150.00

Service Code	HCPCS 27810
Hospital Charge Code	8080122
Hospital Revenue Code	450
Min. Negotiated Rate	$6,077.50
Max. Negotiated Rate	$6,935.50
Rate for Payer: Cash Price	$4,647.50
Rate for Payer: Health Management Network Commercial	$6,077.50
Rate for Payer: Kaiser Permanente Commercial	$6,435.00
Rate for Payer: MDX Hawaii PPO	$6,935.50

27810-Bimalleolar Ankle w/ Manipulation

Facility

$7,150.00

Service Code	HCPCS 27810
Hospital Charge Code	8080122
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$6,935.50
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$3,575.00
Rate for Payer: Cash Price	$4,647.50
Rate for Payer: Cash Price	$4,647.50
Rate for Payer: Cash Price	$4,647.50
Rate for Payer: Devoted Health Medicare	$3,932.50
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	$3,575.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$6,792.50
Rate for Payer: Health Management Network Commercial	$6,077.50
Rate for Payer: Humana Medicare	$3,575.00
Rate for Payer: Kaiser Permanente Commercial	$6,435.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,575.00
Rate for Payer: MDX Hawaii PPO	$6,935.50
Rate for Payer: Ohana Health Plan Medicaid	$3,575.00
Rate for Payer: Ohana Health Plan Medicare	$3,575.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$3,575.00
Rate for Payer: University Health Alliance Commercial	$5,211.64

27818-Trimalleolar Ankle w/ Manipulation

Facility

$7,364.00

Service Code	HCPCS 27818
Hospital Charge Code	8080124
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
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	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,682.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
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 Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$3,682.00
Rate for Payer: University Health Alliance Commercial	$5,160.40

27818-Trimalleolar Ankle w/ Manipulation

Facility

$7,364.00

Service Code	HCPCS 27818
Hospital Charge Code	8080124
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

27825-Distal Tibia w/ Traction or Manipulation

Facility

$7,150.00

Service Code	HCPCS 27825
Hospital Charge Code	8080126
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,935.50
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$3,575.00
Rate for Payer: Cash Price	$4,647.50
Rate for Payer: Cash Price	$4,647.50
Rate for Payer: Cash Price	$4,647.50
Rate for Payer: Devoted Health Medicare	$3,932.50
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,575.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$6,792.50
Rate for Payer: Health Management Network Commercial	$6,077.50
Rate for Payer: Humana Medicare	$3,575.00
Rate for Payer: Kaiser Permanente Commercial	$6,435.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,575.00
Rate for Payer: MDX Hawaii PPO	$6,935.50
Rate for Payer: Ohana Health Plan Medicaid	$3,575.00
Rate for Payer: Ohana Health Plan Medicare	$3,575.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,575.00
Rate for Payer: University Health Alliance Commercial	$5,211.64

27825-Distal Tibia w/ Traction or Manipulation

Facility

$7,150.00

Service Code	HCPCS 27825
Hospital Charge Code	8080126
Hospital Revenue Code	450
Min. Negotiated Rate	$6,077.50
Max. Negotiated Rate	$6,935.50
Rate for Payer: Cash Price	$4,647.50
Rate for Payer: Health Management Network Commercial	$6,077.50
Rate for Payer: Kaiser Permanente Commercial	$6,435.00
Rate for Payer: MDX Hawaii PPO	$6,935.50

27840-Ankle w/o Anesthesia

Facility

$1,434.00

Service Code	HCPCS 27840
Hospital Charge Code	8080096
Hospital Revenue Code	450
Min. Negotiated Rate	$1,218.90
Max. Negotiated Rate	$1,390.98
Rate for Payer: Cash Price	$932.10
Rate for Payer: Health Management Network Commercial	$1,218.90
Rate for Payer: Kaiser Permanente Commercial	$1,290.60
Rate for Payer: MDX Hawaii PPO	$1,390.98

27840-Ankle w/o Anesthesia

Facility

$1,434.00

Service Code	HCPCS 27840
Hospital Charge Code	8080096
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	$717.00
Rate for Payer: Cash Price	$932.10
Rate for Payer: Cash Price	$932.10
Rate for Payer: Cash Price	$932.10
Rate for Payer: Devoted Health Medicare	$788.70
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	$717.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,362.30
Rate for Payer: Health Management Network Commercial	$1,218.90
Rate for Payer: Humana Medicare	$717.00
Rate for Payer: Kaiser Permanente Commercial	$1,290.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$717.00
Rate for Payer: MDX Hawaii PPO	$1,390.98
Rate for Payer: Ohana Health Plan Medicaid	$717.00
Rate for Payer: Ohana Health Plan Medicare	$717.00
Rate for Payer: UnitedHealthcare Medicare	$717.00
Rate for Payer: University Health Alliance Commercial	$1,045.24

27842-Closed Treatment of Ankle Dislocation

Facility

$7,364.00

Service Code	HCPCS 27842
Hospital Charge Code	9334161
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,143.08
Rate for Payer: AlohaCare Medicaid	$672.48
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: Devoted Health Medicare	$4,050.20
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,682.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
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 Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,682.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

27842-Closed Treatment of Ankle Dislocation

Facility

$7,364.00

Service Code	HCPCS 27842
Hospital Charge Code	9334161
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

27899 UNLISTED PROCEDURE, LEG OR ANKLE ProFee

Professional

Both

$378.00

Service Code	HCPCS 27899
Hospital Charge Code	8018117
Hospital Revenue Code	960
Min. Negotiated Rate	$321.30
Max. Negotiated Rate	$321.30
Rate for Payer: Cash Price	$245.70
Rate for Payer: Health Management Network Commercial	$321.30

28001 Incision and drainage, bursa, foot

Professional

Both

$2,299.00

Service Code	HCPCS 28001
Hospital Charge Code	8038295
Hospital Revenue Code	975
Min. Negotiated Rate	$86.46
Max. Negotiated Rate	$1,954.15
Rate for Payer: AlohaCare Medicaid	$96.14
Rate for Payer: AlohaCare Medicare	$86.46
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Cash Price	$1,494.35
Rate for Payer: Devoted Health Medicare	$95.11
Rate for Payer: Hawaii Medical Service Association ABD	$96.14
Rate for Payer: Hawaii Medical Service Association Commercial	$269.92
Rate for Payer: Hawaii Medical Service Association Medicare	$86.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$96.14
Rate for Payer: Hawaii Western Management Group Commercial	$119.08
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Kaiser Permanente Commercial	$95.11
Rate for Payer: Kaiser Permanente Medicaid	$95.11
Rate for Payer: Kaiser Permanente Medicare	$95.11
Rate for Payer: Ohana Health Plan Medicaid	$96.14
Rate for Payer: Ohana Health Plan Medicare	$86.46
Rate for Payer: UnitedHealthcare Medicaid	$96.14
Rate for Payer: UnitedHealthcare Medicare	$86.46
Rate for Payer: University Health Alliance Commercial	$127.57

28008 Fasciotomy, foot and/or toe

Professional

Both

$4,554.00

Service Code	HCPCS 28008
Hospital Charge Code	8038299
Hospital Revenue Code	975
Min. Negotiated Rate	$190.84
Max. Negotiated Rate	$3,870.90
Rate for Payer: AlohaCare Medicaid	$309.99
Rate for Payer: AlohaCare Medicare	$285.55
Rate for Payer: Cash Price	$2,960.10
Rate for Payer: Cash Price	$2,960.10
Rate for Payer: Devoted Health Medicare	$314.11
Rate for Payer: Hawaii Medical Service Association ABD	$309.99
Rate for Payer: Hawaii Medical Service Association Commercial	$506.94
Rate for Payer: Hawaii Medical Service Association Medicare	$285.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$309.99
Rate for Payer: Hawaii Western Management Group Commercial	$190.84
Rate for Payer: Health Management Network Commercial	$3,870.90
Rate for Payer: Kaiser Permanente Commercial	$314.11
Rate for Payer: Kaiser Permanente Medicaid	$314.11
Rate for Payer: Kaiser Permanente Medicare	$314.11
Rate for Payer: Ohana Health Plan Medicaid	$309.99
Rate for Payer: Ohana Health Plan Medicare	$285.55
Rate for Payer: UnitedHealthcare Medicaid	$309.99
Rate for Payer: UnitedHealthcare Medicare	$285.55
Rate for Payer: University Health Alliance Commercial	$472.00

28010 Tenotomy, percutaneous, toe; single tendon

Professional

Both

$666.00

Service Code	HCPCS 28010
Hospital Charge Code	8038300
Hospital Revenue Code	975
Min. Negotiated Rate	$200.98
Max. Negotiated Rate	$566.10
Rate for Payer: AlohaCare Medicaid	$222.10
Rate for Payer: AlohaCare Medicare	$207.09
Rate for Payer: Cash Price	$432.90
Rate for Payer: Cash Price	$432.90
Rate for Payer: Devoted Health Medicare	$227.80
Rate for Payer: Hawaii Medical Service Association ABD	$222.10
Rate for Payer: Hawaii Medical Service Association Medicare	$207.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$222.10
Rate for Payer: Hawaii Western Management Group Commercial	$200.98
Rate for Payer: Health Management Network Commercial	$566.10
Rate for Payer: Kaiser Permanente Commercial	$227.80
Rate for Payer: Kaiser Permanente Medicaid	$227.80
Rate for Payer: Kaiser Permanente Medicare	$227.80
Rate for Payer: Ohana Health Plan Medicaid	$222.10
Rate for Payer: Ohana Health Plan Medicare	$207.09
Rate for Payer: UnitedHealthcare Medicaid	$222.10
Rate for Payer: UnitedHealthcare Medicare	$207.09
Rate for Payer: University Health Alliance Commercial	$329.20

28090 Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy); foot

Professional

Both

$2,238.00

Service Code	HCPCS 28090
Hospital Charge Code	8038318
Hospital Revenue Code	975
Min. Negotiated Rate	$305.69
Max. Negotiated Rate	$1,902.30
Rate for Payer: AlohaCare Medicaid	$326.23
Rate for Payer: AlohaCare Medicare	$305.69
Rate for Payer: Cash Price	$1,454.70
Rate for Payer: Cash Price	$1,454.70
Rate for Payer: Devoted Health Medicare	$336.26
Rate for Payer: Hawaii Medical Service Association ABD	$326.23
Rate for Payer: Hawaii Medical Service Association Commercial	$529.92
Rate for Payer: Hawaii Medical Service Association Medicare	$305.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$326.23
Rate for Payer: Hawaii Western Management Group Commercial	$310.18
Rate for Payer: Health Management Network Commercial	$1,902.30
Rate for Payer: Kaiser Permanente Commercial	$336.26
Rate for Payer: Kaiser Permanente Medicaid	$336.26
Rate for Payer: Kaiser Permanente Medicare	$336.26
Rate for Payer: Ohana Health Plan Medicaid	$326.23
Rate for Payer: Ohana Health Plan Medicare	$305.69
Rate for Payer: UnitedHealthcare Medicaid	$326.23
Rate for Payer: UnitedHealthcare Medicare	$305.69
Rate for Payer: University Health Alliance Commercial	$406.36

Know your out-of-pocket cost for care.

All Charges