54-383 OLD HOSPITAL ROAD, KAPAAU, HI, 96755
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| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychoses | MS-DRG | 885 | 1 | — | — | $15,004 | $15,004 | $15,004 |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 2 | $724 | $470.6 | $390 | $703.25 | $1,400 |
| ED visit level 2 | CPT | 99282 | 2 | $1,288 | $837.2 | $390 | $703.25 | $1,400 |
| ED visit level 3 | CPT | 99283 | 2 | $1,845 | $1,199.25 | $390 | $703.25 | $1,400 |
| ED visit level 4 | CPT | 99284 | 2 | $3,199 | $2,079.35 | $390 | $703.25 | $1,400 |
| ED visit level 5 | CPT | 99285 | 2 | $5,010 | $3,256.5 | $390 | $703.25 | $1,400 |
| Critical care, first hour | CPT | 99291 | 2 | $6,809 | $4,425.85 | $390 | $703.25 | $1,400 |
| imaging | ||||||||
| Chest X-ray single view | CPT | 71045 | 3 | $450 | $292.5 | $13.07 | $17.41 | $34.31 |
| Chest X-ray 2 views | CPT | 71046 | 3 | $540 | $351 | $20.37 | $23.07 | $45.45 |
| Lumbosacral spine X-ray | CPT | 72100 | 5 | $541 | $351.65 | $21.96 | $49.03 | $67.11 |
| Shoulder X-ray | CPT | 73030 | 5 | $541 | $351.65 | $18.84 | $41.94 | $54.83 |
| Humerus X-ray | CPT | 73060 | 5 | $451 | $293.15 | $18.84 | $41.94 | $57.91 |
| Hand X-ray 3 views | CPT | 73130 | 5 | $541 | $351.65 | $19.08 | $38.5 | $61.99 |
| Knee X-ray 1-2 views | CPT | 73560 | 5 | $451 | $293.15 | $17.04 | $37.81 | $64.03 |
| Ankle X-ray 3 views | CPT | 73610 | 5 | $498 | $323.7 | $17.34 | $38.5 | $64.03 |
| Pelvic ultrasound complete | CPT | 76856 | 5 | $722 | $469.3 | $50.35 | $126.3 | $217.66 |
| EKG tracing only | CPT | 93005 | 3 | $334 | $217.1 | $15.16 | $31.7 | $36.14 |
| inpatient | ||||||||
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 1 | — | — | $40,112 | $40,112 | $40,112 |
| COPD w MCC | MS-DRG | 190 | 1 | — | — | $17,596 | $17,596 | $17,596 |
| COPD w CC | MS-DRG | 191 | 1 | — | — | $17,596 | $17,596 | $17,596 |
| COPD w/o CC/MCC | MS-DRG | 192 | 1 | — | — | $17,596 | $17,596 | $17,596 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 1 | — | — | $22,644 | $22,644 | $22,644 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 1 | — | — | $18,024 | $18,024 | $18,024 |
| AMI discharged alive w MCC | MS-DRG | 280 | 1 | — | — | $31,850 | $31,850 | $31,850 |
| AMI discharged alive w CC | MS-DRG | 281 | 1 | — | — | $27,538 | $27,538 | $27,538 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 1 | — | — | $24,115 | $24,115 | $24,115 |
| Heart failure & shock w MCC | MS-DRG | 291 | 1 | — | — | $27,143 | $27,143 | $27,143 |
| Heart failure & shock w CC | MS-DRG | 292 | 1 | — | — | $27,143 | $27,143 | $27,143 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 1 | — | — | $27,143 | $27,143 | $27,143 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 1 | — | — | $20,097 | $20,097 | $20,097 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 1 | — | — | $18,861 | $18,861 | $18,861 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 1 | — | — | $14,456 | $14,456 | $14,456 |
| GI hemorrhage w CC | MS-DRG | 378 | 1 | — | — | $20,328 | $20,328 | $20,328 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 1 | — | — | $15,588 | $15,588 | $15,588 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 1 | — | — | $13,856 | $13,856 | $13,856 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 1 | — | — | $11,607 | $11,607 | $11,607 |
| Kidney/UTI w MCC | MS-DRG | 689 | 1 | — | — | $16,696 | $16,696 | $16,696 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 1 | — | — | $14,255 | $14,255 | $14,255 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 1 | — | — | $38,856 | $38,856 | $38,856 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 1 | — | — | $38,835 | $38,835 | $38,835 |
| Initial hospital care, low complexity | CPT | 99221 | 1 | $156 | $101.4 | $53.33 | $53.33 | $53.33 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 5 | $142 | $92.3 | $11.7 | $20.08 | $23.9 |
| Electrolyte panel | CPT | 80051 | 5 | $98 | $63.7 | $9.69 | $16.64 | $19.8 |
| Comprehensive metabolic panel | CPT | 80053 | 5 | $176 | $114.4 | $14.61 | $25.1 | $29.84 |
| Lipid panel | CPT | 80061 | 5 | $188 | $122.2 | $18.51 | $31.76 | $37.81 |
| Renal function panel | CPT | 80069 | 5 | $137 | $89.05 | $12 | $20.63 | $24.5 |
| Urinalysis non-automated | CPT | 81002 | 5 | $45 | $29.25 | $3.54 | $6.05 | $7.21 |
| Urinalysis automated | CPT | 81003 | 5 | $40 | $26 | $3.1 | $5.36 | $6.34 |
| Glucose quantitative | CPT | 82947 | 5 | $56 | $36.4 | $5.42 | $9.29 | $11.07 |
| Hemoglobin A1c | CPT | 83036 | 5 | $153 | $99.45 | $13.42 | $23.04 | $27.39 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 5 | $295 | $191.75 | $23.21 | $39.88 | $47.41 |
| Complete blood count with automated differential | CPT | 85025 | 5 | $137 | $89.05 | $10.74 | $18.43 | $21.94 |
| Complete blood count without differential | CPT | 85027 | 5 | $104 | $67.6 | $8.95 | $15.34 | $18.26 |
| Urine culture bacterial | CPT | 87086 | 5 | $118 | $76.7 | $11.16 | $19.19 | $22.79 |
| Urine culture identification | CPT | 87088 | 5 | $122 | $79.3 | $10.55 | $18.15 | $21.55 |
| Tissue exam by pathologist level IV | CPT | 88305 | 4 | $392 | $254.8 | $40.64 | $75.75 | $144.69 |
| preventive | ||||||||
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $3,713 | $2,413.45 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $2,173 | $1,412.45 | — | — | — |
| surgery | ||||||||
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 1 | — | — | $76,687 | $76,687 | $76,687 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 1 | — | — | $62,081 | $62,081 | $62,081 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 1 | — | — | $34,772 | $34,772 | $34,772 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 1 | — | — | $25,687 | $25,687 | $25,687 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 1 | — | — | $16,617 | $16,617 | $16,617 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 1 | — | — | $62,316 | $62,316 | $62,316 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 1 | — | — | $80,196 | $80,196 | $80,196 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 1 | — | — | $75,463 | $75,463 | $75,463 |
| Major joint replacement w MCC | MS-DRG | 469 | 1 | — | — | $38,988 | $38,988 | $38,988 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 1 | — | — | $26,470 | $26,470 | $26,470 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 1 | — | — | $47,362 | $47,362 | $47,362 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 1 | — | — | $46,189 | $46,189 | $46,189 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 1 | — | — | $33,285 | $33,285 | $33,285 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 1 | — | — | $49,231 | $49,231 | $49,231 |
| OR procedure for obesity w CC | MS-DRG | 620 | 1 | — | — | $49,231 | $49,231 | $49,231 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 1 | — | — | $49,017 | $49,017 | $49,017 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 1 | — | — | $19,063 | $19,063 | $19,063 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 1 | — | — | $14,896 | $14,896 | $14,896 |
| Payer | Codes covered | Median rate |
|---|---|---|
| hmsa | 73 | $45.45 |
| UnitedHealthcare | 26 | $14.89 |
| uha | 24 | $26.21 |
| hmaa | 23 | $29.84 |
| hma | 21 | $23.8 |
| Kaiser Permanente | 6 | $937.5 |
