Kohala Hospital

All Charges

Charge

Type

Setting

Price

HCHG CLSD TX FX NOT GR TOE W MANIP EA

Facility

$1,441.00

Service Code	HCPCS 28515
Hospital Charge Code	H4500454
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 FX NOT GR TOE W MANIP EA

Facility

$1,441.00

Service Code	HCPCS 28515
Hospital Charge Code	H4500454
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 HIP DISLOC WO ANESTH

Facility

$1,441.00

Service Code	HCPCS 27250
Hospital Charge Code	H4500228
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 HIP DISLOC WO ANESTH

Facility

$1,441.00

Service Code	HCPCS 27250
Hospital Charge Code	H4500228
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 HUM EPICON FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 24565
Hospital Charge Code	H4500230
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 HUM EPICON FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 24565
Hospital Charge Code	H4500230
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 HUMERAL EPICONDYLAR FX MEDIAL/LATERAL WO MANIP

Facility

$1,182.00

Service Code	HCPCS 24560
Hospital Charge Code	H4500893
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$591.00
Rate for Payer: AlohaCare Medicare	$1,063.80
Rate for Payer: Cash Price	$768.30
Rate for Payer: Cash Price	$768.30
Rate for Payer: Devoted Health Medicare	$1,170.18
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	$1,063.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,122.90
Rate for Payer: Health Management Network Commercial	$1,004.70
Rate for Payer: Humana Medicare	$1,063.80
Rate for Payer: Kaiser Permanente Commercial	$1,063.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,063.80
Rate for Payer: MDX Hawaii PPO	$1,146.54
Rate for Payer: Ohana Health Plan Medicaid	$1,063.80
Rate for Payer: Ohana Health Plan Medicare	$1,063.80
Rate for Payer: UnitedHealthcare Medicare	$1,063.80
Rate for Payer: University Health Alliance Commercial	$861.56

HCHG CLSD TX HUMERAL EPICONDYLAR FX MEDIAL/LATERAL WO MANIP

Facility

$1,182.00

Service Code	HCPCS 24560
Hospital Charge Code	H4500893
Hospital Revenue Code	450
Min. Negotiated Rate	$1,004.70
Max. Negotiated Rate	$1,146.54
Rate for Payer: Cash Price	$768.30
Rate for Payer: Health Management Network Commercial	$1,004.70
Rate for Payer: Kaiser Permanente Commercial	$1,063.80
Rate for Payer: MDX Hawaii PPO	$1,146.54

HCHG CLSD TX HUMERAL SHFT FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 24505
Hospital Charge Code	H4500232
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 HUMERAL SHFT FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 24505
Hospital Charge Code	H4500232
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 KNEE DISLOC WO ANESTH

Facility

$1,441.00

Service Code	HCPCS 27550
Hospital Charge Code	H4500236
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 KNEE DISLOC WO ANESTH

Facility

$1,441.00

Service Code	HCPCS 27550
Hospital Charge Code	H4500236
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 LUNATE DISLOC W MANIP

Facility

$5,779.00

Service Code	HCPCS 25690
Hospital Charge Code	H4500238
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$5,721.21
Rate for Payer: AlohaCare Medicaid	$2,889.50
Rate for Payer: AlohaCare Medicare	$5,201.10
Rate for Payer: Cash Price	$3,756.35
Rate for Payer: Cash Price	$3,756.35
Rate for Payer: Devoted Health Medicare	$5,721.21
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	$5,201.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,490.05
Rate for Payer: Health Management Network Commercial	$4,912.15
Rate for Payer: Humana Medicare	$5,201.10
Rate for Payer: Kaiser Permanente Commercial	$5,201.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$5,201.10
Rate for Payer: MDX Hawaii PPO	$5,605.63
Rate for Payer: Ohana Health Plan Medicaid	$5,201.10
Rate for Payer: Ohana Health Plan Medicare	$5,201.10
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$5,201.10
Rate for Payer: University Health Alliance Commercial	$4,212.31

HCHG CLSD TX LUNATE DISLOC W MANIP

Facility

$5,779.00

Service Code	HCPCS 25690
Hospital Charge Code	H4500238
Hospital Revenue Code	450
Min. Negotiated Rate	$4,912.15
Max. Negotiated Rate	$5,605.63
Rate for Payer: Cash Price	$3,756.35
Rate for Payer: Health Management Network Commercial	$4,912.15
Rate for Payer: Kaiser Permanente Commercial	$5,201.10
Rate for Payer: MDX Hawaii PPO	$5,605.63

HCHG CLSD TX MEDIAL MALLEO FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 27762
Hospital Charge Code	H4500244
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	$3,429.47

HCHG CLSD TX MEDIAL MALLEO FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 27762
Hospital Charge Code	H4500244
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 METACARP DISLOC WO ANESTH

Facility

$1,441.00

Service Code	HCPCS 26700
Hospital Charge Code	H4500170
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 METACARP DISLOC WO ANESTH

Facility

$1,441.00

Service Code	HCPCS 26700
Hospital Charge Code	H4500170
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 METACARP FX EA BONE

Facility

$1,441.00

Service Code	HCPCS 26600
Hospital Charge Code	H4500246
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 METACARP FX EA BONE

Facility

$1,441.00

Service Code	HCPCS 26600
Hospital Charge Code	H4500246
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 METACARP FX W MA EA BONE

Facility

$1,441.00

Service Code	HCPCS 26605
Hospital Charge Code	H4500248
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$5,160.40
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	$5,160.40

HCHG CLSD TX METACARP FX W MA EA BONE

Facility

$1,441.00

Service Code	HCPCS 26605
Hospital Charge Code	H4500248
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 METATARSAL FX W MANIP EA

Facility

$1,114.00

Service Code	HCPCS 28475
Hospital Charge Code	H4500252
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$557.00
Rate for Payer: AlohaCare Medicare	$1,002.60
Rate for Payer: Cash Price	$724.10
Rate for Payer: Cash Price	$724.10
Rate for Payer: Devoted Health Medicare	$1,102.86
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	$1,002.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,058.30
Rate for Payer: Health Management Network Commercial	$946.90
Rate for Payer: Humana Medicare	$1,002.60
Rate for Payer: Kaiser Permanente Commercial	$1,002.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,002.60
Rate for Payer: MDX Hawaii PPO	$1,080.58
Rate for Payer: Ohana Health Plan Medicaid	$1,002.60
Rate for Payer: Ohana Health Plan Medicare	$1,002.60
Rate for Payer: UnitedHealthcare Medicare	$1,002.60
Rate for Payer: University Health Alliance Commercial	$811.99

HCHG CLSD TX METATARSAL FX W MANIP EA

Facility

$1,114.00

Service Code	HCPCS 28475
Hospital Charge Code	H4500252
Hospital Revenue Code	450
Min. Negotiated Rate	$946.90
Max. Negotiated Rate	$1,080.58
Rate for Payer: Cash Price	$724.10
Rate for Payer: Health Management Network Commercial	$946.90
Rate for Payer: Kaiser Permanente Commercial	$1,002.60
Rate for Payer: MDX Hawaii PPO	$1,080.58

HCHG CLSD TX MONTEG FX DISLOC ELBOW W MANIP

Facility

$3,560.00

Service Code	HCPCS 24620
Hospital Charge Code	H4500254
Hospital Revenue Code	450
Min. Negotiated Rate	$3,026.00
Max. Negotiated Rate	$3,453.20
Rate for Payer: Cash Price	$2,314.00
Rate for Payer: Health Management Network Commercial	$3,026.00
Rate for Payer: Kaiser Permanente Commercial	$3,204.00
Rate for Payer: MDX Hawaii PPO	$3,453.20

Know your out-of-pocket cost for care.

All Charges