Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG CLOS TX TARSOMT JNT DISLOC WO

Facility

$1,360.00

Service Code	HCPCS 28600
Hospital Charge Code	H4500172
Hospital Revenue Code	450
Min. Negotiated Rate	$1,156.00
Max. Negotiated Rate	$1,319.20
Rate for Payer: Cash Price	$884.00
Rate for Payer: Health Management Network Commercial	$1,156.00
Rate for Payer: MDX Hawaii PPO	$1,319.20

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: 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	$142.59
Rate for Payer: AlohaCare Medicaid	$20.15
Rate for Payer: AlohaCare Medicare	$20.15
Rate for Payer: Cash Price	$95.55
Rate for Payer: Cash Price	$95.55
Rate for Payer: Devoted Health Medicare	$22.16
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	$20.15
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	$20.15
Rate for Payer: Kaiser Permanente Commercial	$92.61
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$20.15
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$22.16
Rate for Payer: Ohana Health Plan Medicare	$20.15
Rate for Payer: UnitedHealthcare Medicaid	$15.14
Rate for Payer: UnitedHealthcare Medicare	$20.15
Rate for Payer: University Health Alliance Commercial	$107.15

HCHG CLSD TX ACROMIOCLAVICULAR DISLOC WO MANIP

Facility

$1,441.00

Service Code	HCPCS 23540
Hospital Charge Code	H4500891
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: MDX Hawaii PPO	$1,397.77

HCHG CLSD TX ACROMIOCLAVICULAR DISLOC WO MANIP

Facility

$1,441.00

Service Code	HCPCS 23540
Hospital Charge Code	H4500891
Hospital Revenue Code	450
Min. Negotiated Rate	$291.40
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Cash Price	$936.65
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	$320.54
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$291.40
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	$291.40
Rate for Payer: Kaiser Permanente Commercial	$907.83
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$1,397.77
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicare	$291.40
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	$291.40
Max. Negotiated Rate	$2,833.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
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	$320.54
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$291.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
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	$291.40
Rate for Payer: Kaiser Permanente Commercial	$907.83
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$1,397.77
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicare	$291.40
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: 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: 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	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$1,899.59
Rate for Payer: AlohaCare Medicare	$1,899.59
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Devoted Health Medicare	$2,089.55
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,899.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
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	$1,899.59
Rate for Payer: Kaiser Permanente Commercial	$2,964.15
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,899.59
Rate for Payer: MDX Hawaii PPO	$4,563.85
Rate for Payer: Ohana Health Plan Medicaid	$2,089.55
Rate for Payer: Ohana Health Plan Medicare	$1,899.59
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
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	$520.00
Max. Negotiated Rate	$4,563.85
Rate for Payer: AlohaCare Medicaid	$1,899.59
Rate for Payer: AlohaCare Medicare	$1,899.59
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Devoted Health Medicare	$2,089.55
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,899.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
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	$1,899.59
Rate for Payer: Kaiser Permanente Commercial	$2,964.15
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,899.59
Rate for Payer: MDX Hawaii PPO	$4,563.85
Rate for Payer: Ohana Health Plan Medicaid	$2,089.55
Rate for Payer: Ohana Health Plan Medicare	$1,899.59
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
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: 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	$4,563.85
Rate for Payer: AlohaCare Medicaid	$1,899.59
Rate for Payer: AlohaCare Medicare	$1,899.59
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Cash Price	$3,058.25
Rate for Payer: Devoted Health Medicare	$2,089.55
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,899.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
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	$1,899.59
Rate for Payer: Kaiser Permanente Commercial	$2,964.15
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,899.59
Rate for Payer: MDX Hawaii PPO	$4,563.85
Rate for Payer: Ohana Health Plan Medicaid	$2,089.55
Rate for Payer: Ohana Health Plan Medicare	$1,899.59
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$3,429.47

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: MDX Hawaii PPO	$4,563.85

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	$291.40
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Cash Price	$936.65
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	$320.54
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$291.40
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	$291.40
Rate for Payer: Kaiser Permanente Commercial	$907.83
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$1,397.77
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$1,050.34

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	$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: MDX Hawaii PPO	$1,397.77

HCHG CLSD TX CARPAL FX W MANIP EA BONE

Facility

$6,676.00

Service Code	HCPCS 25635
Hospital Charge Code	H4500182
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$6,475.72
Rate for Payer: AlohaCare Medicaid	$1,899.59
Rate for Payer: AlohaCare Medicare	$1,899.59
Rate for Payer: Cash Price	$4,339.40
Rate for Payer: Cash Price	$4,339.40
Rate for Payer: Cash Price	$4,339.40
Rate for Payer: Cash Price	$4,339.40
Rate for Payer: Devoted Health Medicare	$2,089.55
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,899.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,342.20
Rate for Payer: Health Management Network Commercial	$5,674.60
Rate for Payer: Humana Medicare	$1,899.59
Rate for Payer: Kaiser Permanente Commercial	$4,205.88
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,899.59
Rate for Payer: MDX Hawaii PPO	$6,475.72
Rate for Payer: Ohana Health Plan Medicaid	$2,089.55
Rate for Payer: Ohana Health Plan Medicare	$1,899.59
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$4,866.14

HCHG CLSD TX CARPAL FX W MANIP EA BONE

Facility

$6,676.00

Service Code	HCPCS 25635
Hospital Charge Code	H4500182
Hospital Revenue Code	450
Min. Negotiated Rate	$5,674.60
Max. Negotiated Rate	$6,475.72
Rate for Payer: Cash Price	$4,339.40
Rate for Payer: Health Management Network Commercial	$5,674.60
Rate for Payer: MDX Hawaii PPO	$6,475.72

HCHG CLSD TX CARPAL SCAPHOID FX

Facility

$1,441.00

Service Code	HCPCS 25622
Hospital Charge Code	H4500186
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: MDX Hawaii PPO	$1,397.77

HCHG CLSD TX CARPAL SCAPHOID FX

Facility

$1,441.00

Service Code	HCPCS 25622
Hospital Charge Code	H4500186
Hospital Revenue Code	450
Min. Negotiated Rate	$291.40
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Cash Price	$936.65
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	$320.54
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$291.40
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	$291.40
Rate for Payer: Kaiser Permanente Commercial	$907.83
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$1,397.77
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$1,050.34

HCHG CLSD TX CARPOMETACARP DISLOC EAJNT

Facility

$1,441.00

Service Code	HCPCS 26670
Hospital Charge Code	H4500188
Hospital Revenue Code	450
Min. Negotiated Rate	$291.40
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Cash Price	$936.65
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	$320.54
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$291.40
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	$291.40
Rate for Payer: Kaiser Permanente Commercial	$907.83
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$1,397.77
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$1,050.34

HCHG CLSD TX CARPOMETACARP DISLOC EAJNT

Facility

$1,441.00

Service Code	HCPCS 26670
Hospital Charge Code	H4500188
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: MDX Hawaii PPO	$1,397.77

HCHG CLSD TX CLAVICLE FX WO MANIP

Facility

$1,441.00

Service Code	HCPCS 23500
Hospital Charge Code	H4500192
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: MDX Hawaii PPO	$1,397.77

HCHG CLSD TX CLAVICLE FX WO MANIP

Facility

$1,441.00

Service Code	HCPCS 23500
Hospital Charge Code	H4500192
Hospital Revenue Code	450
Min. Negotiated Rate	$291.40
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
Rate for Payer: Cash Price	$936.65
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	$320.54
Rate for Payer: Hawaii Medical Service Association ABD	$560.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$291.40
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	$291.40
Rate for Payer: Kaiser Permanente Commercial	$907.83
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$1,397.77
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$1,050.34

HCHG CLSD TX DISLOC ELBOW

Facility

$1,441.00

Service Code	HCPCS 24600
Hospital Charge Code	H4500830
Hospital Revenue Code	450
Min. Negotiated Rate	$291.40
Max. Negotiated Rate	$2,833.00
Rate for Payer: AlohaCare Medicaid	$291.40
Rate for Payer: AlohaCare Medicare	$291.40
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	$320.54
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$291.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
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	$291.40
Rate for Payer: Kaiser Permanente Commercial	$907.83
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$291.40
Rate for Payer: MDX Hawaii PPO	$1,397.77
Rate for Payer: Ohana Health Plan Medicaid	$320.54
Rate for Payer: Ohana Health Plan Medicare	$291.40
Rate for Payer: UnitedHealthcare Medicare	$291.40
Rate for Payer: University Health Alliance Commercial	$1,050.34

HCHG CLSD TX DISLOC ELBOW

Facility

$1,441.00

Service Code	HCPCS 24600
Hospital Charge Code	H4500830
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: MDX Hawaii PPO	$1,397.77

Know your out-of-pocket cost for care.

All Charges