Samuel Mahelona Memorial Hospital

All Charges

Charge

Type

Setting

Price

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC

Facility

$27,802.45

Service Code	MSDRG 470
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$27,802.45
Rate for Payer: Hawaii Medical Service Association Commercial	$27,802.45
Rate for Payer: University Health Alliance Commercial	$10,400.00

MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES

Facility

$36,880.31

Service Code	MSDRG 483
Min. Negotiated Rate	$36,880.31
Max. Negotiated Rate	$36,880.31
Rate for Payer: Hawaii Medical Service Association Commercial	$36,880.31

MAJOR MALE PELVIC PROCEDURES WITH CC/MCC

Facility

$30,954.81

Service Code	MSDRG 707
Min. Negotiated Rate	$30,954.81
Max. Negotiated Rate	$30,954.81
Rate for Payer: Hawaii Medical Service Association Commercial	$30,954.81

MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC

Facility

$28,134.27

Service Code	MSDRG 708
Min. Negotiated Rate	$28,134.27
Max. Negotiated Rate	$28,134.27
Rate for Payer: Hawaii Medical Service Association Commercial	$28,134.27

MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC

Facility

$23,180.56

Service Code	MSDRG 507
Min. Negotiated Rate	$23,180.56
Max. Negotiated Rate	$23,180.56
Rate for Payer: Hawaii Medical Service Association Commercial	$23,180.56

MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC

Facility

$23,180.56

Service Code	MSDRG 508
Min. Negotiated Rate	$23,180.56
Max. Negotiated Rate	$23,180.56
Rate for Payer: Hawaii Medical Service Association Commercial	$23,180.56

MAJOR SKIN DISORDERS WITH MCC

Facility

$40,506.72

Service Code	MSDRG 595
Min. Negotiated Rate	$40,506.72
Max. Negotiated Rate	$40,506.72
Rate for Payer: Hawaii Medical Service Association Commercial	$40,506.72

MAJOR SKIN DISORDERS WITHOUT MCC

Facility

$32,495.44

Service Code	MSDRG 596
Min. Negotiated Rate	$32,495.44
Max. Negotiated Rate	$32,495.44
Rate for Payer: Hawaii Medical Service Association Commercial	$32,495.44

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility

$65,227.90

Service Code	MSDRG 330
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$65,227.90
Rate for Payer: Hawaii Medical Service Association Commercial	$65,227.90
Rate for Payer: University Health Alliance Commercial	$10,400.00

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility

$80,563.10

Service Code	MSDRG 329
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$80,563.10
Rate for Payer: Hawaii Medical Service Association Commercial	$80,563.10
Rate for Payer: University Health Alliance Commercial	$10,400.00

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$36,524.78

Service Code	MSDRG 331
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$36,524.78
Rate for Payer: Hawaii Medical Service Association Commercial	$36,524.78
Rate for Payer: University Health Alliance Commercial	$10,400.00

MAJOR THUMB OR JOINT PROCEDURES

Facility

$34,865.64

Service Code	MSDRG 506
Min. Negotiated Rate	$34,865.64
Max. Negotiated Rate	$34,865.64
Rate for Payer: Hawaii Medical Service Association Commercial	$34,865.64

Malaria Smear, Thick and Thin

Facility

$140.00

Service Code	HCPCS 87015
Hospital Charge Code	12539005
Hospital Revenue Code	306
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$135.80
Rate for Payer: AlohaCare Medicaid	$70.00
Rate for Payer: AlohaCare Medicare	$70.00
Rate for Payer: Cash Price	$91.00
Rate for Payer: Cash Price	$91.00
Rate for Payer: Devoted Health Medicare	$77.00
Rate for Payer: Hawaii Medical Service Association ABD	$9.23
Rate for Payer: Hawaii Medical Service Association Commercial	$8.35
Rate for Payer: Hawaii Medical Service Association Medicare	$70.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.69
Rate for Payer: Hawaii Western Management Group Commercial	$6.68
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Humana Medicare	$70.00
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: Kaiser Permanente Medicare	$70.00
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: Ohana Health Plan Medicaid	$70.00
Rate for Payer: Ohana Health Plan Medicare	$70.00
Rate for Payer: UnitedHealthcare Medicaid	$9.23
Rate for Payer: UnitedHealthcare Medicare	$70.00
Rate for Payer: University Health Alliance Commercial	$17.26

Malaria Smear, Thick and Thin

Facility

$140.00

Service Code	HCPCS 87015
Hospital Charge Code	12539005
Hospital Revenue Code	306
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$91.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: MDX Hawaii PPO	$135.80

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC

Facility

$57,382.54

Service Code	MSDRG 755
Min. Negotiated Rate	$57,382.54
Max. Negotiated Rate	$57,382.54
Rate for Payer: Hawaii Medical Service Association Commercial	$57,382.54

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$57,382.54

Service Code	MSDRG 754
Min. Negotiated Rate	$57,382.54
Max. Negotiated Rate	$57,382.54
Rate for Payer: Hawaii Medical Service Association Commercial	$57,382.54

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$21,545.12

Service Code	MSDRG 756
Min. Negotiated Rate	$21,545.12
Max. Negotiated Rate	$21,545.12
Rate for Payer: Hawaii Medical Service Association Commercial	$21,545.12

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC

Facility

$43,350.96

Service Code	MSDRG 723
Min. Negotiated Rate	$43,350.96
Max. Negotiated Rate	$43,350.96
Rate for Payer: Hawaii Medical Service Association Commercial	$43,350.96

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$43,350.96

Service Code	MSDRG 722
Min. Negotiated Rate	$43,350.96
Max. Negotiated Rate	$43,350.96
Rate for Payer: Hawaii Medical Service Association Commercial	$43,350.96

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$30,148.94

Service Code	MSDRG 724
Min. Negotiated Rate	$30,148.94
Max. Negotiated Rate	$30,148.94
Rate for Payer: Hawaii Medical Service Association Commercial	$30,148.94

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC

Facility

$38,634.26

Service Code	MSDRG 436
Min. Negotiated Rate	$38,634.26
Max. Negotiated Rate	$38,634.26
Rate for Payer: Hawaii Medical Service Association Commercial	$38,634.26

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC

Facility

$38,634.26

Service Code	MSDRG 435
Min. Negotiated Rate	$38,634.26
Max. Negotiated Rate	$38,634.26
Rate for Payer: Hawaii Medical Service Association Commercial	$38,634.26

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC

Facility

$38,634.26

Service Code	MSDRG 437
Min. Negotiated Rate	$38,634.26
Max. Negotiated Rate	$38,634.26
Rate for Payer: Hawaii Medical Service Association Commercial	$38,634.26

MALIGNANT BREAST DISORDERS WITH CC

Facility

$51,978.49

Service Code	MSDRG 598
Min. Negotiated Rate	$51,978.49
Max. Negotiated Rate	$51,978.49
Rate for Payer: Hawaii Medical Service Association Commercial	$51,978.49

MALIGNANT BREAST DISORDERS WITH MCC

Facility

$51,978.49

Service Code	MSDRG 597
Min. Negotiated Rate	$51,978.49
Max. Negotiated Rate	$51,978.49
Rate for Payer: Hawaii Medical Service Association Commercial	$51,978.49

Know your out-of-pocket cost for care.

All Charges