Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC

Facility

$13,960.48

Service Code	MSDRG 306
Min. Negotiated Rate	$13,960.48
Max. Negotiated Rate	$13,960.48
Rate for Payer: Hawaii Medical Service Association Commercial	$13,960.48

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC

Facility

$12,893.89

Service Code	MSDRG 307
Min. Negotiated Rate	$12,893.89
Max. Negotiated Rate	$12,893.89
Rate for Payer: Hawaii Medical Service Association Commercial	$12,893.89

CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC

Facility

$160,035.90

Service Code	MSDRG 275
Min. Negotiated Rate	$160,035.90
Max. Negotiated Rate	$160,035.90
Rate for Payer: Hawaii Medical Service Association Commercial	$160,035.90

CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR

Facility

$103,008.89

Service Code	MSDRG 276
Min. Negotiated Rate	$103,008.89
Max. Negotiated Rate	$103,008.89
Rate for Payer: Hawaii Medical Service Association Commercial	$103,008.89

CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC

Facility

$103,008.89

Service Code	MSDRG 277
Min. Negotiated Rate	$103,008.89
Max. Negotiated Rate	$103,008.89
Rate for Payer: Hawaii Medical Service Association Commercial	$103,008.89

CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC

Facility

$23,085.75

Service Code	MSDRG 258
Min. Negotiated Rate	$23,085.75
Max. Negotiated Rate	$23,085.75
Rate for Payer: Hawaii Medical Service Association Commercial	$23,085.75

CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC

Facility

$23,085.75

Service Code	MSDRG 259
Min. Negotiated Rate	$23,085.75
Max. Negotiated Rate	$23,085.75
Rate for Payer: Hawaii Medical Service Association Commercial	$23,085.75

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC

Facility

$31,168.13

Service Code	MSDRG 261
Min. Negotiated Rate	$31,168.13
Max. Negotiated Rate	$31,168.13
Rate for Payer: Hawaii Medical Service Association Commercial	$31,168.13

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC

Facility

$31,168.13

Service Code	MSDRG 260
Min. Negotiated Rate	$31,168.13
Max. Negotiated Rate	$31,168.13
Rate for Payer: Hawaii Medical Service Association Commercial	$31,168.13

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC

Facility

$31,168.13

Service Code	MSDRG 262
Min. Negotiated Rate	$31,168.13
Max. Negotiated Rate	$31,168.13
Rate for Payer: Hawaii Medical Service Association Commercial	$31,168.13

Cardiac Risk Panel FSI

Facility

$120.00

Service Code	HCPCS 83718
Hospital Charge Code	8404415
Hospital Revenue Code	301
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$116.40
Rate for Payer: AlohaCare Medicaid	$60.00
Rate for Payer: AlohaCare Medicare	$60.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Devoted Health Medicare	$66.00
Rate for Payer: Hawaii Medical Service Association ABD	$11.31
Rate for Payer: Hawaii Medical Service Association Commercial	$10.24
Rate for Payer: Hawaii Medical Service Association Medicare	$60.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.88
Rate for Payer: Hawaii Western Management Group Commercial	$8.19
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Humana Medicare	$60.00
Rate for Payer: Kaiser Permanente Commercial	$108.00
Rate for Payer: Kaiser Permanente Medicaid	$61.20
Rate for Payer: Kaiser Permanente Medicare	$60.00
Rate for Payer: MDX Hawaii PPO	$116.40
Rate for Payer: Ohana Health Plan Medicaid	$60.00
Rate for Payer: Ohana Health Plan Medicare	$60.00
Rate for Payer: UnitedHealthcare Medicaid	$11.31
Rate for Payer: UnitedHealthcare Medicare	$60.00
Rate for Payer: University Health Alliance Commercial	$21.16

Cardiac Risk Panel FSI

Facility

$120.00

Service Code	HCPCS 83718
Hospital Charge Code	8404415
Hospital Revenue Code	301
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$78.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Kaiser Permanente Commercial	$108.00
Rate for Payer: MDX Hawaii PPO	$116.40

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC

Facility

$193,360.92

Service Code	MSDRG 217
Min. Negotiated Rate	$193,360.92
Max. Negotiated Rate	$193,360.92
Rate for Payer: Hawaii Medical Service Association Commercial	$193,360.92

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$193,360.92

Service Code	MSDRG 216
Min. Negotiated Rate	$193,360.92
Max. Negotiated Rate	$193,360.92
Rate for Payer: Hawaii Medical Service Association Commercial	$193,360.92

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$193,360.92

Service Code	MSDRG 218
Min. Negotiated Rate	$193,360.92
Max. Negotiated Rate	$193,360.92
Rate for Payer: Hawaii Medical Service Association Commercial	$193,360.92

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC

Facility

$125,762.81

Service Code	MSDRG 220
Min. Negotiated Rate	$125,762.81
Max. Negotiated Rate	$125,762.81
Rate for Payer: Hawaii Medical Service Association Commercial	$125,762.81

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$125,762.81

Service Code	MSDRG 219
Min. Negotiated Rate	$125,762.81
Max. Negotiated Rate	$125,762.81
Rate for Payer: Hawaii Medical Service Association Commercial	$125,762.81

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$125,762.81

Service Code	MSDRG 221
Min. Negotiated Rate	$125,762.81
Max. Negotiated Rate	$125,762.81
Rate for Payer: Hawaii Medical Service Association Commercial	$125,762.81

Cardiolipin Ab, IgA FSI

Facility

$174.00

Service Code	HCPCS 86147
Hospital Charge Code	12386986
Hospital Revenue Code	302
Min. Negotiated Rate	$147.90
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$113.10
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: MDX Hawaii PPO	$168.78

Cardiolipin Ab, IgA FSI

Facility

$174.00

Service Code	HCPCS 86147
Hospital Charge Code	12386986
Hospital Revenue Code	302
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$168.78
Rate for Payer: AlohaCare Medicaid	$87.00
Rate for Payer: AlohaCare Medicare	$87.00
Rate for Payer: Cash Price	$113.10
Rate for Payer: Cash Price	$113.10
Rate for Payer: Devoted Health Medicare	$95.70
Rate for Payer: Hawaii Medical Service Association ABD	$35.16
Rate for Payer: Hawaii Medical Service Association Commercial	$31.81
Rate for Payer: Hawaii Medical Service Association Medicare	$87.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.92
Rate for Payer: Hawaii Western Management Group Commercial	$25.45
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Humana Medicare	$87.00
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: Kaiser Permanente Medicaid	$88.74
Rate for Payer: Kaiser Permanente Medicare	$87.00
Rate for Payer: MDX Hawaii PPO	$168.78
Rate for Payer: Ohana Health Plan Medicaid	$87.00
Rate for Payer: Ohana Health Plan Medicare	$87.00
Rate for Payer: UnitedHealthcare Medicaid	$35.16
Rate for Payer: UnitedHealthcare Medicare	$87.00
Rate for Payer: University Health Alliance Commercial	$65.75

Cardiolipin Ab, IgG

Facility

$142.00

Service Code	HCPCS 86147
Hospital Charge Code	12528226
Hospital Revenue Code	302
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: MDX Hawaii PPO	$137.74

Cardiolipin Ab, IgG

Facility

$142.00

Service Code	HCPCS 86147
Hospital Charge Code	12528226
Hospital Revenue Code	302
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$71.00
Rate for Payer: AlohaCare Medicare	$71.00
Rate for Payer: Cash Price	$92.30
Rate for Payer: Cash Price	$92.30
Rate for Payer: Devoted Health Medicare	$78.10
Rate for Payer: Hawaii Medical Service Association ABD	$35.16
Rate for Payer: Hawaii Medical Service Association Commercial	$31.81
Rate for Payer: Hawaii Medical Service Association Medicare	$71.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.92
Rate for Payer: Hawaii Western Management Group Commercial	$25.45
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$71.00
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$71.00
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$71.00
Rate for Payer: Ohana Health Plan Medicare	$71.00
Rate for Payer: UnitedHealthcare Medicaid	$35.16
Rate for Payer: UnitedHealthcare Medicare	$71.00
Rate for Payer: University Health Alliance Commercial	$65.75

Cardiolipin Ab, IgG FSI

Facility

$174.00

Service Code	HCPCS 86147
Hospital Charge Code	12333004
Hospital Revenue Code	302
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$168.78
Rate for Payer: AlohaCare Medicaid	$87.00
Rate for Payer: AlohaCare Medicare	$87.00
Rate for Payer: Cash Price	$113.10
Rate for Payer: Cash Price	$113.10
Rate for Payer: Devoted Health Medicare	$95.70
Rate for Payer: Hawaii Medical Service Association ABD	$35.16
Rate for Payer: Hawaii Medical Service Association Commercial	$31.81
Rate for Payer: Hawaii Medical Service Association Medicare	$87.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.92
Rate for Payer: Hawaii Western Management Group Commercial	$25.45
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Humana Medicare	$87.00
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: Kaiser Permanente Medicaid	$88.74
Rate for Payer: Kaiser Permanente Medicare	$87.00
Rate for Payer: MDX Hawaii PPO	$168.78
Rate for Payer: Ohana Health Plan Medicaid	$87.00
Rate for Payer: Ohana Health Plan Medicare	$87.00
Rate for Payer: UnitedHealthcare Medicaid	$35.16
Rate for Payer: UnitedHealthcare Medicare	$87.00
Rate for Payer: University Health Alliance Commercial	$65.75

Cardiolipin Ab, IgG FSI

Facility

$174.00

Service Code	HCPCS 86147
Hospital Charge Code	12333004
Hospital Revenue Code	302
Min. Negotiated Rate	$147.90
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$113.10
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: MDX Hawaii PPO	$168.78

Cardiolipin Ab, IgM

Facility

$142.00

Service Code	HCPCS 86147
Hospital Charge Code	12516676
Hospital Revenue Code	302
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$71.00
Rate for Payer: AlohaCare Medicare	$71.00
Rate for Payer: Cash Price	$92.30
Rate for Payer: Cash Price	$92.30
Rate for Payer: Devoted Health Medicare	$78.10
Rate for Payer: Hawaii Medical Service Association ABD	$35.16
Rate for Payer: Hawaii Medical Service Association Commercial	$31.81
Rate for Payer: Hawaii Medical Service Association Medicare	$71.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.92
Rate for Payer: Hawaii Western Management Group Commercial	$25.45
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$71.00
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$71.00
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$71.00
Rate for Payer: Ohana Health Plan Medicare	$71.00
Rate for Payer: UnitedHealthcare Medicaid	$35.16
Rate for Payer: UnitedHealthcare Medicare	$71.00
Rate for Payer: University Health Alliance Commercial	$65.75

Know your out-of-pocket cost for care.

All Charges