Kohala Hospital

All Charges

Charge

Type

Setting

Price

HCHG CLSD TX SHLDR DISLOC W ANESTH

Facility

$4,705.00

Service Code	HCPCS 23655
Hospital Charge Code	H4500848
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 SHLDR DISLOC W ANESTH

Facility

$4,705.00

Service Code	HCPCS 23655
Hospital Charge Code	H4500848
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 SHLDR DISLOC W FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 23665
Hospital Charge Code	H4500302
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
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	$340.18
Rate for Payer: UnitedHealthcare Medicare	$4,234.50
Rate for Payer: University Health Alliance Commercial	$3,429.47

HCHG CLSD TX SHLDR DISLOC W FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 23665
Hospital Charge Code	H4500302
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 SHLDR DISLOC W NK FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 23675
Hospital Charge Code	H4500300
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 SHLDR DISLOC W NK FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 23675
Hospital Charge Code	H4500300
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 SHLDR DISLOC WO ANESTH

Facility

$1,441.00

Service Code	HCPCS 23650
Hospital Charge Code	H4500298
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 SHLDR DISLOC WO ANESTH

Facility

$1,441.00

Service Code	HCPCS 23650
Hospital Charge Code	H4500298
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 SUPRA/TRAN HUM FX W MANIP

Facility

$5,779.00

Service Code	HCPCS 24535
Hospital Charge Code	H4500310
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 Medicare	$5,201.10
Rate for Payer: University Health Alliance Commercial	$4,212.31

HCHG CLSD TX SUPRA/TRAN HUM FX W MANIP

Facility

$5,779.00

Service Code	HCPCS 24535
Hospital Charge Code	H4500310
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 TALUS FX W MANIP

Facility

$5,779.00

Service Code	HCPCS 28435
Hospital Charge Code	H4500316
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 TALUS FX W MANIP

Facility

$5,779.00

Service Code	HCPCS 28435
Hospital Charge Code	H4500316
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 THUMB DISLOC W MANIP

Facility

$1,393.00

Service Code	HCPCS 26641
Hospital Charge Code	H4500318
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 THUMB DISLOC W MANIP

Facility

$1,393.00

Service Code	HCPCS 26641
Hospital Charge Code	H4500318
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 THUMB FX/DISLOC W MANIP

Facility

$3,514.00

Service Code	HCPCS 26645
Hospital Charge Code	H4500320
Hospital Revenue Code	450
Min. Negotiated Rate	$2,986.90
Max. Negotiated Rate	$3,408.58
Rate for Payer: Cash Price	$2,284.10
Rate for Payer: Health Management Network Commercial	$2,986.90
Rate for Payer: Kaiser Permanente Commercial	$3,162.60
Rate for Payer: MDX Hawaii PPO	$3,408.58

HCHG CLSD TX THUMB FX/DISLOC W MANIP

Facility

$3,514.00

Service Code	HCPCS 26645
Hospital Charge Code	H4500320
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$3,478.86
Rate for Payer: AlohaCare Medicaid	$1,757.00
Rate for Payer: AlohaCare Medicare	$3,162.60
Rate for Payer: Cash Price	$2,284.10
Rate for Payer: Cash Price	$2,284.10
Rate for Payer: Devoted Health Medicare	$3,478.86
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	$3,162.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,338.30
Rate for Payer: Health Management Network Commercial	$2,986.90
Rate for Payer: Humana Medicare	$3,162.60
Rate for Payer: Kaiser Permanente Commercial	$3,162.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,162.60
Rate for Payer: MDX Hawaii PPO	$3,408.58
Rate for Payer: Ohana Health Plan Medicaid	$3,162.60
Rate for Payer: Ohana Health Plan Medicare	$3,162.60
Rate for Payer: UnitedHealthcare Medicare	$3,162.60
Rate for Payer: University Health Alliance Commercial	$2,561.35

HCHG CLSD TX TIB FX PROX W TRAC

Facility

$8,369.00

Service Code	HCPCS 27532
Hospital Charge Code	H4500322
Hospital Revenue Code	450
Min. Negotiated Rate	$7,113.65
Max. Negotiated Rate	$8,117.93
Rate for Payer: Cash Price	$5,439.85
Rate for Payer: Health Management Network Commercial	$7,113.65
Rate for Payer: Kaiser Permanente Commercial	$7,532.10
Rate for Payer: MDX Hawaii PPO	$8,117.93

HCHG CLSD TX TIB FX PROX W TRAC

Facility

$8,369.00

Service Code	HCPCS 27532
Hospital Charge Code	H4500322
Hospital Revenue Code	450
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$8,285.31
Rate for Payer: AlohaCare Medicaid	$4,184.50
Rate for Payer: AlohaCare Medicare	$7,532.10
Rate for Payer: Cash Price	$5,439.85
Rate for Payer: Cash Price	$5,439.85
Rate for Payer: Devoted Health Medicare	$8,285.31
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	$7,532.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,950.55
Rate for Payer: Health Management Network Commercial	$7,113.65
Rate for Payer: Humana Medicare	$7,532.10
Rate for Payer: Kaiser Permanente Commercial	$7,532.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$7,532.10
Rate for Payer: MDX Hawaii PPO	$8,117.93
Rate for Payer: Ohana Health Plan Medicaid	$7,532.10
Rate for Payer: Ohana Health Plan Medicare	$7,532.10
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$7,532.10
Rate for Payer: University Health Alliance Commercial	$6,100.16

HCHG CLSD TX TIB SHAFT FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 27752
Hospital Charge Code	H4500326
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 TIB SHAFT FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 27752
Hospital Charge Code	H4500326
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 TMJ DISLOC

Facility

$1,441.00

Service Code	HCPCS 21480
Hospital Charge Code	H4500330
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 TMJ DISLOC

Facility

$1,441.00

Service Code	HCPCS 21480
Hospital Charge Code	H4500330
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 TRIMALLEO ANKLE FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 27818
Hospital Charge Code	H4500334
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
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	$340.18
Rate for Payer: UnitedHealthcare Medicare	$4,234.50
Rate for Payer: University Health Alliance Commercial	$5,160.40

HCHG CLSD TX TRIMALLEO ANKLE FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 27818
Hospital Charge Code	H4500334
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 ULNAR FX PROX WO MANIP

Facility

$1,441.00

Service Code	HCPCS 24670
Hospital Charge Code	H4500340
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