Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

Stool For Occult Blood POC

Facility

$37.00

Service Code	HCPCS 82270
Hospital Charge Code	8126219
Hospital Revenue Code	301
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$35.89
Rate for Payer: AlohaCare Medicaid	$18.50
Rate for Payer: AlohaCare Medicare	$18.50
Rate for Payer: Cash Price	$24.05
Rate for Payer: Cash Price	$24.05
Rate for Payer: Devoted Health Medicare	$20.35
Rate for Payer: Hawaii Medical Service Association ABD	$4.49
Rate for Payer: Hawaii Medical Service Association Commercial	$5.47
Rate for Payer: Hawaii Medical Service Association Medicare	$18.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.71
Rate for Payer: Hawaii Western Management Group Commercial	$4.38
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Humana Medicare	$18.50
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: Kaiser Permanente Medicare	$18.50
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: Ohana Health Plan Medicaid	$18.50
Rate for Payer: Ohana Health Plan Medicare	$18.50
Rate for Payer: UnitedHealthcare Medicaid	$4.49
Rate for Payer: UnitedHealthcare Medicare	$18.50
Rate for Payer: University Health Alliance Commercial	$8.40

Stool for Occult Blood POCT

Facility

$37.00

Service Code	HCPCS 82272
Hospital Charge Code	8764413
Hospital Revenue Code	983
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$35.89
Rate for Payer: AlohaCare Medicaid	$18.50
Rate for Payer: AlohaCare Medicare	$18.50
Rate for Payer: Cash Price	$24.05
Rate for Payer: Cash Price	$24.05
Rate for Payer: Devoted Health Medicare	$20.35
Rate for Payer: Hawaii Medical Service Association ABD	$4.54
Rate for Payer: Hawaii Medical Service Association Commercial	$5.29
Rate for Payer: Hawaii Medical Service Association Medicare	$18.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.77
Rate for Payer: Hawaii Western Management Group Commercial	$4.23
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Humana Medicare	$18.50
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: Kaiser Permanente Medicare	$18.50
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: Ohana Health Plan Medicaid	$18.50
Rate for Payer: Ohana Health Plan Medicare	$18.50
Rate for Payer: UnitedHealthcare Medicaid	$4.54
Rate for Payer: UnitedHealthcare Medicare	$18.50
Rate for Payer: University Health Alliance Commercial	$8.40

Stool for Occult Blood POCT

Facility

$37.00

Service Code	HCPCS 82272
Hospital Charge Code	8764413
Hospital Revenue Code	983
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$24.05
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: MDX Hawaii PPO	$35.89

Straight Cath Charge

Facility

$451.00

Service Code	HCPCS 51701
Hospital Charge Code	8422803
Hospital Revenue Code	450
Min. Negotiated Rate	$225.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: MDX Hawaii PPO	$437.47
Rate for Payer: AlohaCare Medicaid	$225.50
Rate for Payer: AlohaCare Medicare	$225.50
Rate for Payer: Cash Price	$293.15
Rate for Payer: Cash Price	$293.15
Rate for Payer: Devoted Health Medicare	$248.05
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	$225.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$428.45
Rate for Payer: Health Management Network Commercial	$383.35
Rate for Payer: Humana Medicare	$225.50
Rate for Payer: Kaiser Permanente Commercial	$405.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$225.50
Rate for Payer: Ohana Health Plan Medicaid	$225.50
Rate for Payer: Ohana Health Plan Medicare	$225.50
Rate for Payer: UnitedHealthcare Medicare	$225.50
Rate for Payer: University Health Alliance Commercial	$328.73

Straight Cath Charge

Facility

$451.00

Service Code	HCPCS 51701
Hospital Charge Code	8422803
Hospital Revenue Code	450
Min. Negotiated Rate	$383.35
Max. Negotiated Rate	$437.47
Rate for Payer: Cash Price	$293.15
Rate for Payer: Health Management Network Commercial	$383.35
Rate for Payer: Kaiser Permanente Commercial	$405.90
Rate for Payer: MDX Hawaii PPO	$437.47

Straight Catheter

Facility

$319.00

Service Code	HCPCS 51701
Hospital Charge Code	1909336
Hospital Revenue Code	450
Min. Negotiated Rate	$271.15
Max. Negotiated Rate	$309.43
Rate for Payer: Cash Price	$207.35
Rate for Payer: Health Management Network Commercial	$271.15
Rate for Payer: Kaiser Permanente Commercial	$287.10
Rate for Payer: MDX Hawaii PPO	$309.43

Straight Catheter

Facility

$438.00

Service Code	HCPCS 51701
Hospital Charge Code	1908802
Hospital Revenue Code	450
Min. Negotiated Rate	$372.30
Max. Negotiated Rate	$424.86
Rate for Payer: Cash Price	$284.70
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: MDX Hawaii PPO	$424.86

Straight Catheter

Facility

$438.00

Service Code	HCPCS 51701
Hospital Charge Code	1908802
Hospital Revenue Code	450
Min. Negotiated Rate	$219.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$219.00
Rate for Payer: AlohaCare Medicare	$219.00
Rate for Payer: Cash Price	$284.70
Rate for Payer: Cash Price	$284.70
Rate for Payer: Devoted Health Medicare	$240.90
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	$219.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$416.10
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Humana Medicare	$219.00
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$219.00
Rate for Payer: MDX Hawaii PPO	$424.86
Rate for Payer: Ohana Health Plan Medicaid	$219.00
Rate for Payer: Ohana Health Plan Medicare	$219.00
Rate for Payer: UnitedHealthcare Medicare	$219.00
Rate for Payer: University Health Alliance Commercial	$319.26

Straight Catheter

Facility

$319.00

Service Code	HCPCS 51701
Hospital Charge Code	1909336
Hospital Revenue Code	450
Min. Negotiated Rate	$159.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$159.50
Rate for Payer: AlohaCare Medicare	$159.50
Rate for Payer: Cash Price	$207.35
Rate for Payer: Cash Price	$207.35
Rate for Payer: Devoted Health Medicare	$175.45
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	$159.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$303.05
Rate for Payer: Health Management Network Commercial	$271.15
Rate for Payer: Humana Medicare	$159.50
Rate for Payer: Kaiser Permanente Commercial	$287.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$159.50
Rate for Payer: MDX Hawaii PPO	$309.43
Rate for Payer: Ohana Health Plan Medicaid	$159.50
Rate for Payer: Ohana Health Plan Medicare	$159.50
Rate for Payer: UnitedHealthcare Medicare	$159.50
Rate for Payer: University Health Alliance Commercial	$232.52

Straight Catheter Insertion

Facility

$438.00

Service Code	HCPCS 51701
Hospital Charge Code	8587928
Hospital Revenue Code	450
Min. Negotiated Rate	$219.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$219.00
Rate for Payer: AlohaCare Medicare	$219.00
Rate for Payer: Cash Price	$284.70
Rate for Payer: Cash Price	$284.70
Rate for Payer: Devoted Health Medicare	$240.90
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	$219.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$416.10
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Humana Medicare	$219.00
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$219.00
Rate for Payer: MDX Hawaii PPO	$424.86
Rate for Payer: Ohana Health Plan Medicaid	$219.00
Rate for Payer: Ohana Health Plan Medicare	$219.00
Rate for Payer: UnitedHealthcare Medicare	$219.00
Rate for Payer: University Health Alliance Commercial	$319.26

Straight Catheter Insertion

Facility

$438.00

Service Code	HCPCS 51701
Hospital Charge Code	8587928
Hospital Revenue Code	450
Min. Negotiated Rate	$372.30
Max. Negotiated Rate	$424.86
Rate for Payer: Cash Price	$284.70
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: MDX Hawaii PPO	$424.86

STRAIGHT PLATE, 2.0MM, 10 HOLE

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13000550
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$2,429.85
Rate for Payer: AlohaCare Medicaid	$1,252.50
Rate for Payer: AlohaCare Medicare	$1,252.50
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Devoted Health Medicare	$1,377.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,252.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Humana Medicare	$1,252.50
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: Kaiser Permanente Medicaid	$1,277.55
Rate for Payer: Kaiser Permanente Medicare	$1,252.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: Ohana Health Plan Medicaid	$1,252.50
Rate for Payer: Ohana Health Plan Medicare	$1,252.50
Rate for Payer: UnitedHealthcare Medicare	$1,252.50
Rate for Payer: University Health Alliance Commercial	$1,402.80

STRAIGHT PLATE, 2.0MM, 10 HOLE

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13000550
Hospital Revenue Code	278
Min. Negotiated Rate	$1,402.80
Max. Negotiated Rate	$2,429.85
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: University Health Alliance Commercial	$1,402.80

STRAIGHT PLATE, 2.0MM, 6 HOLE

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13000547
Hospital Revenue Code	278
Min. Negotiated Rate	$818.72
Max. Negotiated Rate	$1,418.14
Rate for Payer: Cash Price	$950.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: University Health Alliance Commercial	$818.72

STRAIGHT PLATE, 2.0MM, 6 HOLE

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13000547
Hospital Revenue Code	278
Min. Negotiated Rate	$731.00
Max. Negotiated Rate	$1,418.14
Rate for Payer: AlohaCare Medicaid	$731.00
Rate for Payer: AlohaCare Medicare	$731.00
Rate for Payer: Cash Price	$950.30
Rate for Payer: Devoted Health Medicare	$804.10
Rate for Payer: Hawaii Medical Service Association Medicare	$731.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Humana Medicare	$731.00
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: Kaiser Permanente Medicaid	$745.62
Rate for Payer: Kaiser Permanente Medicare	$731.00
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: Ohana Health Plan Medicaid	$731.00
Rate for Payer: Ohana Health Plan Medicare	$731.00
Rate for Payer: UnitedHealthcare Medicare	$731.00
Rate for Payer: University Health Alliance Commercial	$818.72

STRAIGHT PLATE, 2.0MM, 6 HOLE,REINFORCED

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13000551
Hospital Revenue Code	278
Min. Negotiated Rate	$731.00
Max. Negotiated Rate	$1,418.14
Rate for Payer: AlohaCare Medicaid	$731.00
Rate for Payer: AlohaCare Medicare	$731.00
Rate for Payer: Cash Price	$950.30
Rate for Payer: Devoted Health Medicare	$804.10
Rate for Payer: Hawaii Medical Service Association Medicare	$731.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Humana Medicare	$731.00
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: Kaiser Permanente Medicaid	$745.62
Rate for Payer: Kaiser Permanente Medicare	$731.00
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: Ohana Health Plan Medicaid	$731.00
Rate for Payer: Ohana Health Plan Medicare	$731.00
Rate for Payer: UnitedHealthcare Medicare	$731.00
Rate for Payer: University Health Alliance Commercial	$818.72

STRAIGHT PLATE, 2.0MM, 6 HOLE,REINFORCED

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13000551
Hospital Revenue Code	278
Min. Negotiated Rate	$818.72
Max. Negotiated Rate	$1,418.14
Rate for Payer: Cash Price	$950.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: University Health Alliance Commercial	$818.72

STRAIGHT PLATE, 2.0MM, 8 HOLE,REINFORCED

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13001322
Hospital Revenue Code	278
Min. Negotiated Rate	$1,402.80
Max. Negotiated Rate	$2,429.85
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: University Health Alliance Commercial	$1,402.80

STRAIGHT PLATE, 2.0MM, 8 HOLE,REINFORCED

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13001322
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$2,429.85
Rate for Payer: AlohaCare Medicaid	$1,252.50
Rate for Payer: AlohaCare Medicare	$1,252.50
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Devoted Health Medicare	$1,377.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,252.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Humana Medicare	$1,252.50
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: Kaiser Permanente Medicaid	$1,277.55
Rate for Payer: Kaiser Permanente Medicare	$1,252.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: Ohana Health Plan Medicaid	$1,252.50
Rate for Payer: Ohana Health Plan Medicare	$1,252.50
Rate for Payer: UnitedHealthcare Medicare	$1,252.50
Rate for Payer: University Health Alliance Commercial	$1,402.80

STRAIGHT PLATE, 2.4MM, 10 HOLE

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13001321
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$2,429.85
Rate for Payer: AlohaCare Medicaid	$1,252.50
Rate for Payer: AlohaCare Medicare	$1,252.50
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Devoted Health Medicare	$1,377.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,252.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Humana Medicare	$1,252.50
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: Kaiser Permanente Medicaid	$1,277.55
Rate for Payer: Kaiser Permanente Medicare	$1,252.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: Ohana Health Plan Medicaid	$1,252.50
Rate for Payer: Ohana Health Plan Medicare	$1,252.50
Rate for Payer: UnitedHealthcare Medicare	$1,252.50
Rate for Payer: University Health Alliance Commercial	$1,402.80

STRAIGHT PLATE, 2.4MM, 10 HOLE

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13001321
Hospital Revenue Code	278
Min. Negotiated Rate	$1,402.80
Max. Negotiated Rate	$2,429.85
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: University Health Alliance Commercial	$1,402.80

STRAIGHT PLATE, 2.4MM, 20 HOLE

Facility

$2,090.00

Service Code	HCPCS C1713
Hospital Charge Code	13004972
Hospital Revenue Code	278
Min. Negotiated Rate	$1,170.40
Max. Negotiated Rate	$2,027.30
Rate for Payer: Cash Price	$1,358.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,463.00
Rate for Payer: Health Management Network Commercial	$1,776.50
Rate for Payer: Kaiser Permanente Commercial	$1,881.00
Rate for Payer: MDX Hawaii PPO	$2,027.30
Rate for Payer: University Health Alliance Commercial	$1,170.40

STRAIGHT PLATE, 2.4MM, 20 HOLE

Facility

$2,090.00

Service Code	HCPCS C1713
Hospital Charge Code	13004972
Hospital Revenue Code	278
Min. Negotiated Rate	$1,045.00
Max. Negotiated Rate	$2,027.30
Rate for Payer: AlohaCare Medicaid	$1,045.00
Rate for Payer: AlohaCare Medicare	$1,045.00
Rate for Payer: Cash Price	$1,358.50
Rate for Payer: Devoted Health Medicare	$1,149.50
Rate for Payer: Hawaii Medical Service Association Medicare	$1,045.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,463.00
Rate for Payer: Health Management Network Commercial	$1,776.50
Rate for Payer: Humana Medicare	$1,045.00
Rate for Payer: Kaiser Permanente Commercial	$1,881.00
Rate for Payer: Kaiser Permanente Medicaid	$1,065.90
Rate for Payer: Kaiser Permanente Medicare	$1,045.00
Rate for Payer: MDX Hawaii PPO	$2,027.30
Rate for Payer: Ohana Health Plan Medicaid	$1,045.00
Rate for Payer: Ohana Health Plan Medicare	$1,045.00
Rate for Payer: UnitedHealthcare Medicare	$1,045.00
Rate for Payer: University Health Alliance Commercial	$1,170.40

STRAIGHT PLATE, 2.4MM,20 HOLE,REINFORCED

Facility

$2,090.00

Service Code	HCPCS C1713
Hospital Charge Code	13004975
Hospital Revenue Code	278
Min. Negotiated Rate	$1,045.00
Max. Negotiated Rate	$2,027.30
Rate for Payer: AlohaCare Medicaid	$1,045.00
Rate for Payer: AlohaCare Medicare	$1,045.00
Rate for Payer: Cash Price	$1,358.50
Rate for Payer: Devoted Health Medicare	$1,149.50
Rate for Payer: Hawaii Medical Service Association Medicare	$1,045.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,463.00
Rate for Payer: Health Management Network Commercial	$1,776.50
Rate for Payer: Humana Medicare	$1,045.00
Rate for Payer: Kaiser Permanente Commercial	$1,881.00
Rate for Payer: Kaiser Permanente Medicaid	$1,065.90
Rate for Payer: Kaiser Permanente Medicare	$1,045.00
Rate for Payer: MDX Hawaii PPO	$2,027.30
Rate for Payer: Ohana Health Plan Medicaid	$1,045.00
Rate for Payer: Ohana Health Plan Medicare	$1,045.00
Rate for Payer: UnitedHealthcare Medicare	$1,045.00
Rate for Payer: University Health Alliance Commercial	$1,170.40

STRAIGHT PLATE, 2.4MM,20 HOLE,REINFORCED

Facility

$2,090.00

Service Code	HCPCS C1713
Hospital Charge Code	13004975
Hospital Revenue Code	278
Min. Negotiated Rate	$1,170.40
Max. Negotiated Rate	$2,027.30
Rate for Payer: Cash Price	$1,358.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,463.00
Rate for Payer: Health Management Network Commercial	$1,776.50
Rate for Payer: Kaiser Permanente Commercial	$1,881.00
Rate for Payer: MDX Hawaii PPO	$2,027.30
Rate for Payer: University Health Alliance Commercial	$1,170.40

Know your out-of-pocket cost for care.

All Charges