Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG CLSD TX PATELLAR DISLOC

Facility

$1,441.00

Service Code	HCPCS 27560
Hospital Charge Code	H4500398
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 PATELLAR DISLOC

Facility

$1,441.00

Service Code	HCPCS 27560
Hospital Charge Code	H4500398
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 PHALANGEAL SHFT FX W MANIP EA

Facility

$1,441.00

Service Code	HCPCS 26725
Hospital Charge Code	H4500268
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 PHALANGEAL SHFT FX W MANIP EA

Facility

$1,441.00

Service Code	HCPCS 26725
Hospital Charge Code	H4500268
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 POST HIP ARTH WO ANESTH

Facility

$1,441.00

Service Code	HCPCS 27265
Hospital Charge Code	H4500270
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 POST HIP ARTH WO ANESTH

Facility

$1,441.00

Service Code	HCPCS 27265
Hospital Charge Code	H4500270
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 PROX FIB/SHFT FX W MANIP

Facility

$6,669.00

Service Code	HCPCS 27781
Hospital Charge Code	H4500274
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$6,468.93
Rate for Payer: AlohaCare Medicaid	$1,899.59
Rate for Payer: AlohaCare Medicare	$1,899.59
Rate for Payer: Cash Price	$4,334.85
Rate for Payer: Cash Price	$4,334.85
Rate for Payer: Cash Price	$4,334.85
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	$6,335.55
Rate for Payer: Health Management Network Commercial	$5,668.65
Rate for Payer: Humana Medicare	$1,899.59
Rate for Payer: Kaiser Permanente Commercial	$4,201.47
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,899.59
Rate for Payer: MDX Hawaii PPO	$6,468.93
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	$4,861.03

HCHG CLSD TX PROX FIB/SHFT FX W MANIP

Facility

$6,669.00

Service Code	HCPCS 27781
Hospital Charge Code	H4500274
Hospital Revenue Code	450
Min. Negotiated Rate	$5,668.65
Max. Negotiated Rate	$6,468.93
Rate for Payer: Cash Price	$4,334.85
Rate for Payer: Health Management Network Commercial	$5,668.65
Rate for Payer: MDX Hawaii PPO	$6,468.93

HCHG CLSD TX RADL HEAD/NECK FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 24655
Hospital Charge Code	H4500290
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 RADL HEAD/NECK FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 24655
Hospital Charge Code	H4500290
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
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: 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 Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$3,429.47

HCHG CLSD TX RAD SHAFT FX W DISLOC

Facility

$4,109.00

Service Code	HCPCS 25520
Hospital Charge Code	H4500282
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$3,985.73
Rate for Payer: AlohaCare Medicaid	$1,899.59
Rate for Payer: AlohaCare Medicare	$1,899.59
Rate for Payer: Cash Price	$2,670.85
Rate for Payer: Cash Price	$2,670.85
Rate for Payer: Cash Price	$2,670.85
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	$3,903.55
Rate for Payer: Health Management Network Commercial	$3,492.65
Rate for Payer: Humana Medicare	$1,899.59
Rate for Payer: Kaiser Permanente Commercial	$2,588.67
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,899.59
Rate for Payer: MDX Hawaii PPO	$3,985.73
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	$2,995.05

HCHG CLSD TX RAD SHAFT FX W DISLOC

Facility

$4,109.00

Service Code	HCPCS 25520
Hospital Charge Code	H4500282
Hospital Revenue Code	450
Min. Negotiated Rate	$3,492.65
Max. Negotiated Rate	$3,985.73
Rate for Payer: Cash Price	$2,670.85
Rate for Payer: Health Management Network Commercial	$3,492.65
Rate for Payer: MDX Hawaii PPO	$3,985.73

HCHG CLSD TX RAD SHAFT FX W MANIP

Facility

$7,050.00

Service Code	HCPCS 25505
Hospital Charge Code	H4500284
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$6,838.50
Rate for Payer: AlohaCare Medicaid	$1,899.59
Rate for Payer: AlohaCare Medicare	$1,899.59
Rate for Payer: Cash Price	$4,582.50
Rate for Payer: Cash Price	$4,582.50
Rate for Payer: Cash Price	$4,582.50
Rate for Payer: Cash Price	$4,582.50
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	$6,697.50
Rate for Payer: Health Management Network Commercial	$5,992.50
Rate for Payer: Humana Medicare	$1,899.59
Rate for Payer: Kaiser Permanente Commercial	$4,441.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,899.59
Rate for Payer: MDX Hawaii PPO	$6,838.50
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	$5,138.74

HCHG CLSD TX RAD SHAFT FX W MANIP

Facility

$7,050.00

Service Code	HCPCS 25505
Hospital Charge Code	H4500284
Hospital Revenue Code	450
Min. Negotiated Rate	$5,992.50
Max. Negotiated Rate	$6,838.50
Rate for Payer: Cash Price	$4,582.50
Rate for Payer: Health Management Network Commercial	$5,992.50
Rate for Payer: MDX Hawaii PPO	$6,838.50

HCHG CLSD TX RAD/ULNA SHAFT FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 25565
Hospital Charge Code	H4500286
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 RAD/ULNA SHAFT FX W MANIP

Facility

$4,705.00

Service Code	HCPCS 25565
Hospital Charge Code	H4500286
Hospital Revenue Code	450
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$10,679.55
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 Medicare	$1,899.59
Rate for Payer: University Health Alliance Commercial	$10,679.55

HCHG CLSD TX SCAPULAR FX WO MANIP

Facility

$1,441.00

Service Code	HCPCS 23570
Hospital Charge Code	H4500296
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 SCAPULAR FX WO MANIP

Facility

$1,441.00

Service Code	HCPCS 23570
Hospital Charge Code	H4500296
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 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: 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	$393.00
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: 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	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,899.59
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	$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 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	$4,563.85
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 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	$393.00
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: 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 Medicare	$1,899.59
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: 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	$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

Know your out-of-pocket cost for care.

All Charges