Kohala Hospital

All Charges

Charge

Type

Setting

Price

HCHG CLAVICLE COMPLETE

Facility

$604.00

Service Code	HCPCS 73000
Hospital Charge Code	H3200282
Hospital Revenue Code	320
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$597.96
Rate for Payer: AlohaCare Medicaid	$302.00
Rate for Payer: AlohaCare Medicare	$543.60
Rate for Payer: Cash Price	$392.60
Rate for Payer: Cash Price	$392.60
Rate for Payer: Devoted Health Medicare	$597.96
Rate for Payer: Hawaii Medical Service Association ABD	$17.04
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$543.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.60
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Humana Medicare	$543.60
Rate for Payer: Kaiser Permanente Commercial	$543.60
Rate for Payer: Kaiser Permanente Medicaid	$308.04
Rate for Payer: Kaiser Permanente Medicare	$543.60
Rate for Payer: MDX Hawaii PPO	$585.88
Rate for Payer: Ohana Health Plan Medicaid	$543.60
Rate for Payer: Ohana Health Plan Medicare	$543.60
Rate for Payer: UnitedHealthcare Medicaid	$17.04
Rate for Payer: UnitedHealthcare Medicare	$543.60
Rate for Payer: University Health Alliance Commercial	$56.28

HCHG CLAVICLE COMPLETE

Facility

$604.00

Service Code	HCPCS 73000
Hospital Charge Code	H3200282
Hospital Revenue Code	320
Min. Negotiated Rate	$513.40
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$392.60
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Kaiser Permanente Commercial	$543.60
Rate for Payer: MDX Hawaii PPO	$585.88

HCHG CLAVICLE PORT COMPLETE

Facility

$604.00

Service Code	HCPCS 73000
Hospital Charge Code	H3200284
Hospital Revenue Code	320
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$597.96
Rate for Payer: AlohaCare Medicaid	$302.00
Rate for Payer: AlohaCare Medicare	$543.60
Rate for Payer: Cash Price	$392.60
Rate for Payer: Cash Price	$392.60
Rate for Payer: Devoted Health Medicare	$597.96
Rate for Payer: Hawaii Medical Service Association ABD	$17.04
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$543.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.60
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Humana Medicare	$543.60
Rate for Payer: Kaiser Permanente Commercial	$543.60
Rate for Payer: Kaiser Permanente Medicaid	$308.04
Rate for Payer: Kaiser Permanente Medicare	$543.60
Rate for Payer: MDX Hawaii PPO	$585.88
Rate for Payer: Ohana Health Plan Medicaid	$543.60
Rate for Payer: Ohana Health Plan Medicare	$543.60
Rate for Payer: UnitedHealthcare Medicaid	$17.04
Rate for Payer: UnitedHealthcare Medicare	$543.60
Rate for Payer: University Health Alliance Commercial	$56.28

HCHG CLAVICLE PORT COMPLETE

Facility

$604.00

Service Code	HCPCS 73000
Hospital Charge Code	H3200284
Hospital Revenue Code	320
Min. Negotiated Rate	$513.40
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$392.60
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Kaiser Permanente Commercial	$543.60
Rate for Payer: MDX Hawaii PPO	$585.88

HCHG CLOSED TREATMENT OF ACETABULUM FRACTURE WITH MANIPULATION, WITH OR WITHOUT TRACTION

Facility

$4,200.00

Service Code	HCPCS 27222
Hospital Charge Code	H4501149
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$4,158.00
Rate for Payer: AlohaCare Medicaid	$2,100.00
Rate for Payer: AlohaCare Medicare	$3,780.00
Rate for Payer: Cash Price	$2,730.00
Rate for Payer: Cash Price	$2,730.00
Rate for Payer: Devoted Health Medicare	$4,158.00
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	$3,780.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,990.00
Rate for Payer: Health Management Network Commercial	$3,570.00
Rate for Payer: Humana Medicare	$3,780.00
Rate for Payer: Kaiser Permanente Commercial	$3,780.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,780.00
Rate for Payer: MDX Hawaii PPO	$4,074.00
Rate for Payer: Ohana Health Plan Medicaid	$3,780.00
Rate for Payer: Ohana Health Plan Medicare	$3,780.00
Rate for Payer: UnitedHealthcare Medicare	$3,780.00
Rate for Payer: University Health Alliance Commercial	$3,061.38

HCHG CLOSED TREATMENT OF ACETABULUM FRACTURE WITH MANIPULATION, WITH OR WITHOUT TRACTION

Facility

$4,200.00

Service Code	HCPCS 27222
Hospital Charge Code	H4501149
Hospital Revenue Code	450
Min. Negotiated Rate	$3,570.00
Max. Negotiated Rate	$4,074.00
Rate for Payer: Cash Price	$2,730.00
Rate for Payer: Health Management Network Commercial	$3,570.00
Rate for Payer: Kaiser Permanente Commercial	$3,780.00
Rate for Payer: MDX Hawaii PPO	$4,074.00

HCHG CLOSED TREATMENT PATELLAR DISLOCATION W ANES

Facility

$1,441.00

Service Code	HCPCS 27562
Hospital Charge Code	H4501115
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

HCHG CLOSED TREATMENT PATELLAR DISLOCATION W ANES

Facility

$1,441.00

Service Code	HCPCS 27562
Hospital Charge Code	H4501115
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$720.50
Rate for Payer: AlohaCare Medicare	$1,296.90
Rate for Payer: Cash Price	$936.65
Rate for Payer: Cash Price	$936.65
Rate for Payer: Devoted Health Medicare	$1,426.59
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	$1,296.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
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	$1,296.90
Rate for Payer: Kaiser Permanente Commercial	$1,296.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,296.90
Rate for Payer: MDX Hawaii PPO	$1,397.77
Rate for Payer: Ohana Health Plan Medicaid	$1,296.90
Rate for Payer: Ohana Health Plan Medicare	$1,296.90
Rate for Payer: UnitedHealthcare Medicare	$1,296.90
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG CLOSED TX - POST HIP ARTHROPLASTY DISLOCATION, REQ ANESTHESIA

Facility

$4,705.00

Service Code	HCPCS 27266
Hospital Charge Code	H4501052
Hospital Revenue Code	450
Min. Negotiated Rate	$3,999.25
Max. Negotiated Rate	$4,563.85
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Health Management Network Commercial	$3,999.25
Rate for Payer: Kaiser Permanente Commercial	$4,234.50
Rate for Payer: MDX Hawaii PPO	$4,563.85

HCHG CLOSED TX - POST HIP ARTHROPLASTY DISLOCATION, REQ ANESTHESIA

Facility

$4,705.00

Service Code	HCPCS 27266
Hospital Charge Code	H4501052
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$2,352.50
Rate for Payer: AlohaCare Medicare	$4,234.50
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Devoted Health Medicare	$4,657.95
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	$4,234.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,469.75
Rate for Payer: Health Management Network Commercial	$3,999.25
Rate for Payer: Humana Medicare	$4,234.50
Rate for Payer: Kaiser Permanente Commercial	$4,234.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$4,234.50
Rate for Payer: MDX Hawaii PPO	$4,563.85
Rate for Payer: Ohana Health Plan Medicaid	$4,234.50
Rate for Payer: Ohana Health Plan Medicare	$4,234.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,234.50
Rate for Payer: University Health Alliance Commercial	$5,160.40

HCHG CLOSTRIDIUM DIFFICILE TOXIN EIA

Facility

$223.00

Service Code	HCPCS 87324
Hospital Charge Code	H3060659
Hospital Revenue Code	306
Min. Negotiated Rate	$189.55
Max. Negotiated Rate	$216.31
Rate for Payer: Cash Price	$144.95
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Kaiser Permanente Commercial	$200.70
Rate for Payer: MDX Hawaii PPO	$216.31

HCHG CLOSTRIDIUM DIFFICILE TOXIN EIA

Facility

$223.00

Service Code	HCPCS 87324
Hospital Charge Code	H3060659
Hospital Revenue Code	306
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$220.77
Rate for Payer: AlohaCare Medicaid	$111.50
Rate for Payer: AlohaCare Medicare	$200.70
Rate for Payer: Cash Price	$144.95
Rate for Payer: Cash Price	$144.95
Rate for Payer: Devoted Health Medicare	$220.77
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$200.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Humana Medicare	$200.70
Rate for Payer: Kaiser Permanente Commercial	$200.70
Rate for Payer: Kaiser Permanente Medicaid	$113.73
Rate for Payer: Kaiser Permanente Medicare	$200.70
Rate for Payer: MDX Hawaii PPO	$216.31
Rate for Payer: Ohana Health Plan Medicaid	$200.70
Rate for Payer: Ohana Health Plan Medicare	$200.70
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$200.70
Rate for Payer: University Health Alliance Commercial	$31.01

HCHG CLOZAPINE 90

Facility

$147.00

Service Code	HCPCS 80159
Hospital Charge Code	H3010392
Hospital Revenue Code	301
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$95.55
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59

HCHG CLOZAPINE 90

Facility

$147.00

Service Code	HCPCS 80159
Hospital Charge Code	H3010392
Hospital Revenue Code	301
Min. Negotiated Rate	$15.14
Max. Negotiated Rate	$145.53
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$132.30
Rate for Payer: Cash Price	$95.55
Rate for Payer: Cash Price	$95.55
Rate for Payer: Devoted Health Medicare	$145.53
Rate for Payer: Hawaii Medical Service Association ABD	$25.56
Rate for Payer: Hawaii Medical Service Association Commercial	$25.19
Rate for Payer: Hawaii Medical Service Association Medicare	$132.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.84
Rate for Payer: Hawaii Western Management Group Commercial	$20.15
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$132.30
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$132.30
Rate for Payer: Ohana Health Plan Medicare	$132.30
Rate for Payer: UnitedHealthcare Medicaid	$15.14
Rate for Payer: UnitedHealthcare Medicare	$132.30
Rate for Payer: University Health Alliance Commercial	$107.15

HCHG CLSD TX ACROMIOCLAVICULAR DISLOC WO MANIP

Facility

$1,393.00

Service Code	HCPCS 23540
Hospital Charge Code	H4500891
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$696.50
Rate for Payer: AlohaCare Medicare	$1,253.70
Rate for Payer: Cash Price	$905.45
Rate for Payer: Cash Price	$905.45
Rate for Payer: Devoted Health Medicare	$1,379.07
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	$1,253.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,323.35
Rate for Payer: Health Management Network Commercial	$1,184.05
Rate for Payer: Humana Medicare	$1,253.70
Rate for Payer: Kaiser Permanente Commercial	$1,253.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,253.70
Rate for Payer: MDX Hawaii PPO	$1,351.21
Rate for Payer: Ohana Health Plan Medicaid	$1,253.70
Rate for Payer: Ohana Health Plan Medicare	$1,253.70
Rate for Payer: UnitedHealthcare Medicare	$1,253.70
Rate for Payer: University Health Alliance Commercial	$1,015.36

HCHG CLSD TX ACROMIOCLAVICULAR DISLOC WO MANIP

Facility

$1,393.00

Service Code	HCPCS 23540
Hospital Charge Code	H4500891
Hospital Revenue Code	450
Min. Negotiated Rate	$1,184.05
Max. Negotiated Rate	$1,351.21
Rate for Payer: Cash Price	$905.45
Rate for Payer: Health Management Network Commercial	$1,184.05
Rate for Payer: Kaiser Permanente Commercial	$1,253.70
Rate for Payer: MDX Hawaii PPO	$1,351.21

HCHG CLSD TX ANKLE DISLOC

Facility

$1,441.00

Service Code	HCPCS 27840
Hospital Charge Code	H4500392
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$720.50
Rate for Payer: AlohaCare Medicare	$1,296.90
Rate for Payer: Cash Price	$936.65
Rate for Payer: Cash Price	$936.65
Rate for Payer: Devoted Health Medicare	$1,426.59
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	$1,296.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
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	$1,296.90
Rate for Payer: Kaiser Permanente Commercial	$1,296.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,296.90
Rate for Payer: MDX Hawaii PPO	$1,397.77
Rate for Payer: Ohana Health Plan Medicaid	$1,296.90
Rate for Payer: Ohana Health Plan Medicare	$1,296.90
Rate for Payer: UnitedHealthcare Medicare	$1,296.90
Rate for Payer: University Health Alliance Commercial	$1,050.34

HCHG CLSD TX ANKLE DISLOC

Facility

$1,441.00

Service Code	HCPCS 27840
Hospital Charge Code	H4500392
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

HCHG CLSD TX ANKLE DISLOC W ANESTH

Facility

$4,705.00

Service Code	HCPCS 27842
Hospital Charge Code	H4500844
Hospital Revenue Code	450
Min. Negotiated Rate	$3,999.25
Max. Negotiated Rate	$4,563.85
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Health Management Network Commercial	$3,999.25
Rate for Payer: Kaiser Permanente Commercial	$4,234.50
Rate for Payer: MDX Hawaii PPO	$4,563.85

HCHG CLSD TX ANKLE DISLOC W ANESTH

Facility

$4,705.00

Service Code	HCPCS 27842
Hospital Charge Code	H4500844
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$4,657.95
Rate for Payer: AlohaCare Medicaid	$2,352.50
Rate for Payer: AlohaCare Medicare	$4,234.50
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Devoted Health Medicare	$4,657.95
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	$4,234.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,469.75
Rate for Payer: Health Management Network Commercial	$3,999.25
Rate for Payer: Humana Medicare	$4,234.50
Rate for Payer: Kaiser Permanente Commercial	$4,234.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$4,234.50
Rate for Payer: MDX Hawaii PPO	$4,563.85
Rate for Payer: Ohana Health Plan Medicaid	$4,234.50
Rate for Payer: Ohana Health Plan Medicare	$4,234.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,234.50
Rate for Payer: University Health Alliance Commercial	$4,035.20

HCHG CLSD TX ARTICULAR FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 26742
Hospital Charge Code	H4500174
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$4,657.95
Rate for Payer: AlohaCare Medicaid	$2,352.50
Rate for Payer: AlohaCare Medicare	$4,234.50
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Devoted Health Medicare	$4,657.95
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	$4,234.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,469.75
Rate for Payer: Health Management Network Commercial	$3,999.25
Rate for Payer: Humana Medicare	$4,234.50
Rate for Payer: Kaiser Permanente Commercial	$4,234.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$4,234.50
Rate for Payer: MDX Hawaii PPO	$4,563.85
Rate for Payer: Ohana Health Plan Medicaid	$4,234.50
Rate for Payer: Ohana Health Plan Medicare	$4,234.50
Rate for Payer: UnitedHealthcare Medicare	$4,234.50
Rate for Payer: University Health Alliance Commercial	$3,429.47

HCHG CLSD TX ARTICULAR FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 26742
Hospital Charge Code	H4500174
Hospital Revenue Code	450
Min. Negotiated Rate	$3,999.25
Max. Negotiated Rate	$4,563.85
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Health Management Network Commercial	$3,999.25
Rate for Payer: Kaiser Permanente Commercial	$4,234.50
Rate for Payer: MDX Hawaii PPO	$4,563.85

HCHG CLSD TX BIMALLEO ANKLE FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 27810
Hospital Charge Code	H4500180
Hospital Revenue Code	450
Min. Negotiated Rate	$3,999.25
Max. Negotiated Rate	$4,563.85
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Health Management Network Commercial	$3,999.25
Rate for Payer: Kaiser Permanente Commercial	$4,234.50
Rate for Payer: MDX Hawaii PPO	$4,563.85

HCHG CLSD TX BIMALLEO ANKLE FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 27810
Hospital Charge Code	H4500180
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,657.95
Rate for Payer: Ohana Health Plan Medicare	$4,234.50
Rate for Payer: AlohaCare Medicaid	$2,352.50
Rate for Payer: AlohaCare Medicare	$4,234.50
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Devoted Health Medicare	$4,657.95
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	$4,234.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,469.75
Rate for Payer: Health Management Network Commercial	$3,999.25
Rate for Payer: Humana Medicare	$4,234.50
Rate for Payer: Kaiser Permanente Commercial	$4,234.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$4,234.50
Rate for Payer: MDX Hawaii PPO	$4,563.85
Rate for Payer: Ohana Health Plan Medicaid	$4,234.50
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$4,234.50
Rate for Payer: University Health Alliance Commercial	$3,429.47

HCHG CLSD TX CALCANEAL FX WO MANIP

Facility

$1,441.00

Service Code	HCPCS 28400
Hospital Charge Code	H4500850
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$720.50
Rate for Payer: AlohaCare Medicare	$1,296.90
Rate for Payer: Cash Price	$936.65
Rate for Payer: Cash Price	$936.65
Rate for Payer: Devoted Health Medicare	$1,426.59
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	$1,296.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
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	$1,296.90
Rate for Payer: Kaiser Permanente Commercial	$1,296.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,296.90
Rate for Payer: MDX Hawaii PPO	$1,397.77
Rate for Payer: Ohana Health Plan Medicaid	$1,296.90
Rate for Payer: Ohana Health Plan Medicare	$1,296.90
Rate for Payer: UnitedHealthcare Medicare	$1,296.90
Rate for Payer: University Health Alliance Commercial	$1,050.34

Know your out-of-pocket cost for care.

All Charges