Leahi Hospital

All Charges

Charge

Type

Setting

Price

CORONARY BYPASS WITH PTCA WITH MCC

Facility

$140,505.46

Service Code	MSDRG 231
Min. Negotiated Rate	$83,515.52
Max. Negotiated Rate	$140,505.46
Rate for Payer: AlohaCare Medicare	$83,515.52
Rate for Payer: Hawaii Medical Service Association Commercial	$140,505.46
Rate for Payer: Hawaii Medical Service Association Medicare	$83,515.52
Rate for Payer: Humana Medicare	$83,515.52
Rate for Payer: Kaiser Permanente Medicare	$83,515.52
Rate for Payer: Ohana Health Plan Medicare	$83,515.52
Rate for Payer: UnitedHealthcare Medicare	$83,515.52

CORONARY BYPASS WITH PTCA WITHOUT MCC

Facility

$140,505.46

Service Code	MSDRG 232
Min. Negotiated Rate	$60,184.93
Max. Negotiated Rate	$140,505.46
Rate for Payer: AlohaCare Medicare	$60,184.93
Rate for Payer: Hawaii Medical Service Association Commercial	$140,505.46
Rate for Payer: Hawaii Medical Service Association Medicare	$60,184.93
Rate for Payer: Humana Medicare	$60,184.93
Rate for Payer: Kaiser Permanente Medicare	$60,184.93
Rate for Payer: Ohana Health Plan Medicare	$60,184.93
Rate for Payer: UnitedHealthcare Medicare	$60,184.93

CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC

Facility

$43,083.90

Service Code	MSDRG 323
Min. Negotiated Rate	$40,483.02
Max. Negotiated Rate	$43,083.90
Rate for Payer: AlohaCare Medicare	$43,083.90
Rate for Payer: Hawaii Medical Service Association Commercial	$40,483.02
Rate for Payer: Hawaii Medical Service Association Medicare	$43,083.90
Rate for Payer: Humana Medicare	$43,083.90
Rate for Payer: Kaiser Permanente Medicare	$43,083.90
Rate for Payer: Ohana Health Plan Medicare	$43,083.90
Rate for Payer: UnitedHealthcare Medicare	$43,083.90

CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$40,483.02

Service Code	MSDRG 324
Min. Negotiated Rate	$31,490.07
Max. Negotiated Rate	$40,483.02
Rate for Payer: AlohaCare Medicare	$31,490.07
Rate for Payer: Hawaii Medical Service Association Commercial	$40,483.02
Rate for Payer: Hawaii Medical Service Association Medicare	$31,490.07
Rate for Payer: Humana Medicare	$31,490.07
Rate for Payer: Kaiser Permanente Medicare	$31,490.07
Rate for Payer: Ohana Health Plan Medicare	$31,490.07
Rate for Payer: UnitedHealthcare Medicare	$31,490.07

CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE

Facility

$38,112.82

Service Code	MSDRG 325
Min. Negotiated Rate	$32,075.47
Max. Negotiated Rate	$38,112.82
Rate for Payer: AlohaCare Medicare	$32,075.47
Rate for Payer: Hawaii Medical Service Association Commercial	$38,112.82
Rate for Payer: Hawaii Medical Service Association Medicare	$32,075.47
Rate for Payer: Humana Medicare	$32,075.47
Rate for Payer: Kaiser Permanente Medicare	$32,075.47
Rate for Payer: Ohana Health Plan Medicare	$32,075.47
Rate for Payer: UnitedHealthcare Medicare	$32,075.47

Covid - 19 Administration

Facility

$203.00

Service Code	HCPCS 90480
Hospital Charge Code	Covid ADM
Hospital Revenue Code	771
Min. Negotiated Rate	$31.14
Max. Negotiated Rate	$196.91
Rate for Payer: AlohaCare Medicaid	$101.50
Rate for Payer: Cash Price	$131.95
Rate for Payer: Cash Price	$131.95
Rate for Payer: Hawaii Medical Service Association ABD	$47.20
Rate for Payer: Hawaii Medical Service Association Commercial	$60.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$47.20
Rate for Payer: Hawaii Western Management Group Commercial	$192.85
Rate for Payer: Health Management Network Commercial	$172.55
Rate for Payer: Kaiser Permanente Commercial	$182.70
Rate for Payer: Kaiser Permanente Medicaid	$103.53
Rate for Payer: MDX Hawaii PPO	$196.91
Rate for Payer: UnitedHealthcare Medicaid	$31.14
Rate for Payer: University Health Alliance Commercial	$147.97

Covid - 19 Administration

Facility

$203.00

Service Code	HCPCS 90480
Hospital Charge Code	Covid ADM
Hospital Revenue Code	771
Min. Negotiated Rate	$172.55
Max. Negotiated Rate	$196.91
Rate for Payer: Cash Price	$131.95
Rate for Payer: Health Management Network Commercial	$172.55
Rate for Payer: Kaiser Permanente Commercial	$182.70
Rate for Payer: MDX Hawaii PPO	$196.91

CPK Total

Facility

$138.00

Service Code	HCPCS 82550
Hospital Charge Code	82550
Hospital Revenue Code	301
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$133.86
Rate for Payer: AlohaCare Medicaid	$69.00
Rate for Payer: Cash Price	$89.70
Rate for Payer: Cash Price	$89.70
Rate for Payer: Hawaii Medical Service Association ABD	$9.01
Rate for Payer: Hawaii Medical Service Association Commercial	$8.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.46
Rate for Payer: Hawaii Western Management Group Commercial	$6.51
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: Kaiser Permanente Medicaid	$70.38
Rate for Payer: MDX Hawaii PPO	$133.86
Rate for Payer: UnitedHealthcare Medicaid	$9.01
Rate for Payer: University Health Alliance Commercial	$16.84

CPK Total

Facility

$138.00

Service Code	HCPCS 82550
Hospital Charge Code	82550
Hospital Revenue Code	301
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$89.70
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: MDX Hawaii PPO	$133.86

CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC

Facility

$24,507.87

Service Code	MSDRG 073
Min. Negotiated Rate	$16,246.77
Max. Negotiated Rate	$24,507.87
Rate for Payer: AlohaCare Medicare	$16,246.77
Rate for Payer: Hawaii Medical Service Association Commercial	$24,507.87
Rate for Payer: Hawaii Medical Service Association Medicare	$16,246.77
Rate for Payer: Humana Medicare	$16,246.77
Rate for Payer: Kaiser Permanente Medicare	$16,246.77
Rate for Payer: Ohana Health Plan Medicare	$16,246.77
Rate for Payer: UnitedHealthcare Medicare	$16,246.77

CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC

Facility

$22,327.28

Service Code	MSDRG 074
Min. Negotiated Rate	$10,594.72
Max. Negotiated Rate	$22,327.28
Rate for Payer: AlohaCare Medicare	$10,594.72
Rate for Payer: Hawaii Medical Service Association Commercial	$22,327.28
Rate for Payer: Hawaii Medical Service Association Medicare	$10,594.72
Rate for Payer: Humana Medicare	$10,594.72
Rate for Payer: Kaiser Permanente Medicare	$10,594.72
Rate for Payer: Ohana Health Plan Medicare	$10,594.72
Rate for Payer: UnitedHealthcare Medicare	$10,594.72

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC

Facility

$89,095.82

Service Code	MSDRG 026
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$89,095.82
Rate for Payer: AlohaCare Medicare	$31,078.11
Rate for Payer: Hawaii Medical Service Association Commercial	$89,095.82
Rate for Payer: Hawaii Medical Service Association Medicare	$31,078.11
Rate for Payer: Humana Medicare	$31,078.11
Rate for Payer: Kaiser Permanente Medicare	$31,078.11
Rate for Payer: Ohana Health Plan Medicare	$31,078.11
Rate for Payer: UnitedHealthcare Medicare	$31,078.11
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC

Facility

$89,095.82

Service Code	MSDRG 025
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$89,095.82
Rate for Payer: AlohaCare Medicare	$45,245.19
Rate for Payer: Hawaii Medical Service Association Commercial	$89,095.82
Rate for Payer: Hawaii Medical Service Association Medicare	$45,245.19
Rate for Payer: Humana Medicare	$45,245.19
Rate for Payer: Kaiser Permanente Medicare	$45,245.19
Rate for Payer: Ohana Health Plan Medicare	$45,245.19
Rate for Payer: UnitedHealthcare Medicare	$45,245.19
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$76,652.27

Service Code	MSDRG 027
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$76,652.27
Rate for Payer: AlohaCare Medicare	$25,299.91
Rate for Payer: Hawaii Medical Service Association Commercial	$76,652.27
Rate for Payer: Hawaii Medical Service Association Medicare	$25,299.91
Rate for Payer: Humana Medicare	$25,299.91
Rate for Payer: Kaiser Permanente Medicare	$25,299.91
Rate for Payer: Ohana Health Plan Medicare	$25,299.91
Rate for Payer: UnitedHealthcare Medicare	$25,299.91
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$224,860.87

Service Code	MSDRG 955
Min. Negotiated Rate	$66,773.23
Max. Negotiated Rate	$224,860.87
Rate for Payer: AlohaCare Medicare	$66,773.23
Rate for Payer: Hawaii Medical Service Association Commercial	$224,860.87
Rate for Payer: Hawaii Medical Service Association Medicare	$66,773.23
Rate for Payer: Humana Medicare	$66,773.23
Rate for Payer: Kaiser Permanente Medicare	$66,773.23
Rate for Payer: Ohana Health Plan Medicare	$66,773.23
Rate for Payer: UnitedHealthcare Medicare	$66,773.23

CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR

Facility

$104,857.65

Service Code	MSDRG 023
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$104,857.65
Rate for Payer: AlohaCare Medicare	$56,909.98
Rate for Payer: Hawaii Medical Service Association Commercial	$104,857.65
Rate for Payer: Hawaii Medical Service Association Medicare	$56,909.98
Rate for Payer: Humana Medicare	$56,909.98
Rate for Payer: Kaiser Permanente Medicare	$56,909.98
Rate for Payer: Ohana Health Plan Medicare	$56,909.98
Rate for Payer: UnitedHealthcare Medicare	$56,909.98
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC

Facility

$99,927.63

Service Code	MSDRG 024
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$99,927.63
Rate for Payer: AlohaCare Medicare	$38,989.00
Rate for Payer: Hawaii Medical Service Association Commercial	$99,927.63
Rate for Payer: Hawaii Medical Service Association Medicare	$38,989.00
Rate for Payer: Humana Medicare	$38,989.00
Rate for Payer: Kaiser Permanente Medicare	$38,989.00
Rate for Payer: Ohana Health Plan Medicare	$38,989.00
Rate for Payer: UnitedHealthcare Medicare	$38,989.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

C-Reactive protein

Facility

$105.00

Service Code	HCPCS 86140
Hospital Charge Code	86140
Hospital Revenue Code	302
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$101.85
Rate for Payer: AlohaCare Medicaid	$52.50
Rate for Payer: Cash Price	$68.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Medicaid	$53.55
Rate for Payer: MDX Hawaii PPO	$101.85
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: University Health Alliance Commercial	$13.38

C-Reactive protein

Facility

$105.00

Service Code	HCPCS 86140
Hospital Charge Code	86140
Hospital Revenue Code	302
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$68.25
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: MDX Hawaii PPO	$101.85

Creatinine blood

Facility

$88.00

Service Code	HCPCS 82565
Hospital Charge Code	82565
Hospital Revenue Code	301
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$57.20
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Kaiser Permanente Commercial	$79.20
Rate for Payer: MDX Hawaii PPO	$85.36

Creatinine blood

Facility

$88.00

Service Code	HCPCS 82565
Hospital Charge Code	82565
Hospital Revenue Code	301
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$85.36
Rate for Payer: AlohaCare Medicaid	$44.00
Rate for Payer: Cash Price	$57.20
Rate for Payer: Cash Price	$57.20
Rate for Payer: Hawaii Medical Service Association ABD	$7.07
Rate for Payer: Hawaii Medical Service Association Commercial	$6.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.42
Rate for Payer: Hawaii Western Management Group Commercial	$5.12
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Kaiser Permanente Commercial	$79.20
Rate for Payer: Kaiser Permanente Medicaid	$44.88
Rate for Payer: MDX Hawaii PPO	$85.36
Rate for Payer: UnitedHealthcare Medicaid	$7.07
Rate for Payer: University Health Alliance Commercial	$13.25

Creatinine Other Source KSO

Facility

$89.00

Service Code	HCPCS 82570
Hospital Charge Code	82570
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: Cash Price	$57.85
Rate for Payer: Cash Price	$57.85
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: University Health Alliance Commercial	$13.38

Creatinine Other Source KSO

Facility

$89.00

Service Code	HCPCS 82570
Hospital Charge Code	82570
Hospital Revenue Code	301
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$57.85
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33

Cult aerobic ID

Facility

$174.00

Service Code	HCPCS 87077
Hospital Charge Code	87077
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$168.78
Rate for Payer: AlohaCare Medicaid	$87.00
Rate for Payer: Cash Price	$113.10
Rate for Payer: Cash Price	$113.10
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.72
Rate for Payer: Hawaii Western Management Group Commercial	$8.08
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: Kaiser Permanente Medicaid	$88.74
Rate for Payer: MDX Hawaii PPO	$168.78
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: University Health Alliance Commercial	$20.89

Cult aerobic ID

Facility

$174.00

Service Code	HCPCS 87077
Hospital Charge Code	87077
Hospital Revenue Code	306
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

Know your out-of-pocket cost for care.

All Charges