Leahi Hospital

All Charges

Charge

Type

Setting

Price

Cult all other isol

Facility

$193.00

Service Code	HCPCS 87070
Hospital Charge Code	87070
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$96.50
Rate for Payer: Cash Price	$125.45
Rate for Payer: Cash Price	$125.45
Rate for Payer: Hawaii Medical Service Association ABD	$11.90
Rate for Payer: Hawaii Medical Service Association Commercial	$10.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.50
Rate for Payer: Hawaii Western Management Group Commercial	$8.62
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: UnitedHealthcare Medicaid	$11.90
Rate for Payer: University Health Alliance Commercial	$22.26

Cult all other isol

Facility

$193.00

Service Code	HCPCS 87070
Hospital Charge Code	87070
Hospital Revenue Code	306
Min. Negotiated Rate	$164.05
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$125.45
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: MDX Hawaii PPO	$187.21

Cult blood

Facility

$195.00

Service Code	HCPCS 87040
Hospital Charge Code	87040
Hospital Revenue Code	306
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$189.15
Rate for Payer: AlohaCare Medicaid	$97.50
Rate for Payer: Cash Price	$126.75
Rate for Payer: Cash Price	$126.75
Rate for Payer: Hawaii Medical Service Association ABD	$14.27
Rate for Payer: Hawaii Medical Service Association Commercial	$12.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.98
Rate for Payer: Hawaii Western Management Group Commercial	$10.32
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Kaiser Permanente Commercial	$175.50
Rate for Payer: Kaiser Permanente Medicaid	$99.45
Rate for Payer: MDX Hawaii PPO	$189.15
Rate for Payer: UnitedHealthcare Medicaid	$14.27
Rate for Payer: University Health Alliance Commercial	$26.68

Cult blood

Facility

$195.00

Service Code	HCPCS 87040
Hospital Charge Code	87040
Hospital Revenue Code	306
Min. Negotiated Rate	$165.75
Max. Negotiated Rate	$189.15
Rate for Payer: Cash Price	$126.75
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Kaiser Permanente Commercial	$175.50
Rate for Payer: MDX Hawaii PPO	$189.15

Culture AFB CSF

Facility

$169.00

Service Code	HCPCS 87116
Hospital Charge Code	87116
Hospital Revenue Code	306
Min. Negotiated Rate	$143.65
Max. Negotiated Rate	$163.93
Rate for Payer: Cash Price	$109.85
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: Kaiser Permanente Commercial	$152.10
Rate for Payer: MDX Hawaii PPO	$163.93

Culture AFB CSF

Facility

$169.00

Service Code	HCPCS 87116
Hospital Charge Code	87116
Hospital Revenue Code	306
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$163.93
Rate for Payer: AlohaCare Medicaid	$84.50
Rate for Payer: Cash Price	$109.85
Rate for Payer: Cash Price	$109.85
Rate for Payer: Hawaii Medical Service Association ABD	$13.63
Rate for Payer: Hawaii Medical Service Association Commercial	$13.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.31
Rate for Payer: Hawaii Western Management Group Commercial	$10.80
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: Kaiser Permanente Commercial	$152.10
Rate for Payer: Kaiser Permanente Medicaid	$86.19
Rate for Payer: MDX Hawaii PPO	$163.93
Rate for Payer: UnitedHealthcare Medicaid	$13.63
Rate for Payer: University Health Alliance Commercial	$25.49

Cult urine

Facility

$149.00

Service Code	HCPCS 87086
Hospital Charge Code	87086
Hospital Revenue Code	306
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$144.53
Rate for Payer: AlohaCare Medicaid	$74.50
Rate for Payer: Cash Price	$96.85
Rate for Payer: Cash Price	$96.85
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.72
Rate for Payer: Hawaii Western Management Group Commercial	$8.07
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: Kaiser Permanente Medicaid	$75.99
Rate for Payer: MDX Hawaii PPO	$144.53
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: University Health Alliance Commercial	$20.87

Cult urine

Facility

$149.00

Service Code	HCPCS 87086
Hospital Charge Code	87086
Hospital Revenue Code	306
Min. Negotiated Rate	$126.65
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$96.85
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: MDX Hawaii PPO	$144.53

Cult urine ID

Facility

$146.00

Service Code	HCPCS 87088
Hospital Charge Code	87088
Hospital Revenue Code	306
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$141.62
Rate for Payer: AlohaCare Medicaid	$73.00
Rate for Payer: Cash Price	$94.90
Rate for Payer: Cash Price	$94.90
Rate for Payer: Hawaii Medical Service Association ABD	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$10.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.08
Rate for Payer: Hawaii Western Management Group Commercial	$8.09
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Kaiser Permanente Commercial	$131.40
Rate for Payer: Kaiser Permanente Medicaid	$74.46
Rate for Payer: MDX Hawaii PPO	$141.62
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: University Health Alliance Commercial	$19.74

Cult urine ID

Facility

$146.00

Service Code	HCPCS 87088
Hospital Charge Code	87088
Hospital Revenue Code	306
Min. Negotiated Rate	$124.10
Max. Negotiated Rate	$141.62
Rate for Payer: Cash Price	$94.90
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Kaiser Permanente Commercial	$131.40
Rate for Payer: MDX Hawaii PPO	$141.62

Cytomegalovirus Quant SO

Facility

$728.00

Service Code	HCPCS 87497
Hospital Charge Code	87497
Hospital Revenue Code	306
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$706.16
Rate for Payer: AlohaCare Medicaid	$364.00
Rate for Payer: Cash Price	$473.20
Rate for Payer: Cash Price	$473.20
Rate for Payer: Hawaii Medical Service Association ABD	$59.20
Rate for Payer: Hawaii Medical Service Association Commercial	$53.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$62.16
Rate for Payer: Hawaii Western Management Group Commercial	$42.84
Rate for Payer: Health Management Network Commercial	$618.80
Rate for Payer: Kaiser Permanente Commercial	$655.20
Rate for Payer: Kaiser Permanente Medicaid	$371.28
Rate for Payer: MDX Hawaii PPO	$706.16
Rate for Payer: UnitedHealthcare Medicaid	$59.20
Rate for Payer: University Health Alliance Commercial	$110.72

Cytomegalovirus Quant SO

Facility

$728.00

Service Code	HCPCS 87497
Hospital Charge Code	87497
Hospital Revenue Code	306
Min. Negotiated Rate	$618.80
Max. Negotiated Rate	$706.16
Rate for Payer: Cash Price	$473.20
Rate for Payer: Health Management Network Commercial	$618.80
Rate for Payer: Kaiser Permanente Commercial	$655.20
Rate for Payer: MDX Hawaii PPO	$706.16

D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC

Facility

$20,630.44

Service Code	MSDRG 744
Min. Negotiated Rate	$15,643.32
Max. Negotiated Rate	$20,630.44
Rate for Payer: AlohaCare Medicare	$20,630.44
Rate for Payer: Hawaii Medical Service Association Commercial	$15,643.32
Rate for Payer: Hawaii Medical Service Association Medicare	$20,630.44
Rate for Payer: Humana Medicare	$20,630.44
Rate for Payer: Kaiser Permanente Medicare	$20,630.44
Rate for Payer: Ohana Health Plan Medicare	$20,630.44
Rate for Payer: UnitedHealthcare Medicare	$20,630.44

D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC

Facility

$15,643.32

Service Code	MSDRG 745
Min. Negotiated Rate	$11,646.30
Max. Negotiated Rate	$15,643.32
Rate for Payer: AlohaCare Medicare	$11,646.30
Rate for Payer: Hawaii Medical Service Association Commercial	$15,643.32
Rate for Payer: Hawaii Medical Service Association Medicare	$11,646.30
Rate for Payer: Humana Medicare	$11,646.30
Rate for Payer: Kaiser Permanente Medicare	$11,646.30
Rate for Payer: Ohana Health Plan Medicare	$11,646.30
Rate for Payer: UnitedHealthcare Medicare	$11,646.30

DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC

Facility

$25,835.18

Service Code	MSDRG 056
Min. Negotiated Rate	$23,330.82
Max. Negotiated Rate	$25,835.18
Rate for Payer: AlohaCare Medicare	$23,330.82
Rate for Payer: Hawaii Medical Service Association Commercial	$25,835.18
Rate for Payer: Hawaii Medical Service Association Medicare	$23,330.82
Rate for Payer: Humana Medicare	$23,330.82
Rate for Payer: Kaiser Permanente Medicare	$23,330.82
Rate for Payer: Ohana Health Plan Medicare	$23,330.82
Rate for Payer: UnitedHealthcare Medicare	$23,330.82

DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC

Facility

$25,835.18

Service Code	MSDRG 057
Min. Negotiated Rate	$13,204.43
Max. Negotiated Rate	$25,835.18
Rate for Payer: AlohaCare Medicare	$13,204.43
Rate for Payer: Hawaii Medical Service Association Commercial	$25,835.18
Rate for Payer: Hawaii Medical Service Association Medicare	$13,204.43
Rate for Payer: Humana Medicare	$13,204.43
Rate for Payer: Kaiser Permanente Medicare	$13,204.43
Rate for Payer: Ohana Health Plan Medicare	$13,204.43
Rate for Payer: UnitedHealthcare Medicare	$13,204.43

DENTAL AND ORAL DISEASES WITH CC

Facility

$19,933.38

Service Code	MSDRG 158
Min. Negotiated Rate	$9,402.22
Max. Negotiated Rate	$19,933.38
Rate for Payer: AlohaCare Medicare	$9,402.22
Rate for Payer: Hawaii Medical Service Association Commercial	$19,933.38
Rate for Payer: Hawaii Medical Service Association Medicare	$9,402.22
Rate for Payer: Humana Medicare	$9,402.22
Rate for Payer: Kaiser Permanente Medicare	$9,402.22
Rate for Payer: Ohana Health Plan Medicare	$9,402.22
Rate for Payer: UnitedHealthcare Medicare	$9,402.22

DENTAL AND ORAL DISEASES WITH MCC

Facility

$19,933.38

Service Code	MSDRG 157
Min. Negotiated Rate	$17,355.51
Max. Negotiated Rate	$19,933.38
Rate for Payer: AlohaCare Medicare	$17,355.51
Rate for Payer: Hawaii Medical Service Association Commercial	$19,933.38
Rate for Payer: Hawaii Medical Service Association Medicare	$17,355.51
Rate for Payer: Humana Medicare	$17,355.51
Rate for Payer: Kaiser Permanente Medicare	$17,355.51
Rate for Payer: Ohana Health Plan Medicare	$17,355.51
Rate for Payer: UnitedHealthcare Medicare	$17,355.51

DENTAL AND ORAL DISEASES WITHOUT CC/MCC

Facility

$19,933.38

Service Code	MSDRG 159
Min. Negotiated Rate	$7,418.34
Max. Negotiated Rate	$19,933.38
Rate for Payer: AlohaCare Medicare	$7,418.34
Rate for Payer: Hawaii Medical Service Association Commercial	$19,933.38
Rate for Payer: Hawaii Medical Service Association Medicare	$7,418.34
Rate for Payer: Humana Medicare	$7,418.34
Rate for Payer: Kaiser Permanente Medicare	$7,418.34
Rate for Payer: Ohana Health Plan Medicare	$7,418.34
Rate for Payer: UnitedHealthcare Medicare	$7,418.34

DEPRESSIVE NEUROSES

Facility

$10,002.24

Service Code	MSDRG 881
Min. Negotiated Rate	$9,708.73
Max. Negotiated Rate	$10,002.24
Rate for Payer: AlohaCare Medicare	$9,708.73
Rate for Payer: Hawaii Medical Service Association Commercial	$10,002.24
Rate for Payer: Hawaii Medical Service Association Medicare	$9,708.73
Rate for Payer: Humana Medicare	$9,708.73
Rate for Payer: Kaiser Permanente Medicare	$9,708.73
Rate for Payer: Ohana Health Plan Medicare	$9,708.73
Rate for Payer: UnitedHealthcare Medicare	$9,708.73

DIABETES WITH CC

Facility

$14,932.26

Service Code	MSDRG 638
Min. Negotiated Rate	$9,268.19
Max. Negotiated Rate	$14,932.26
Rate for Payer: AlohaCare Medicare	$9,268.19
Rate for Payer: Hawaii Medical Service Association Commercial	$14,932.26
Rate for Payer: Hawaii Medical Service Association Medicare	$9,268.19
Rate for Payer: Humana Medicare	$9,268.19
Rate for Payer: Kaiser Permanente Medicare	$9,268.19
Rate for Payer: Ohana Health Plan Medicare	$9,268.19
Rate for Payer: UnitedHealthcare Medicare	$9,268.19

DIABETES WITH MCC

Facility

$15,074.47

Service Code	MSDRG 637
Min. Negotiated Rate	$14,595.01
Max. Negotiated Rate	$15,074.47
Rate for Payer: AlohaCare Medicare	$14,595.01
Rate for Payer: Hawaii Medical Service Association Commercial	$15,074.47
Rate for Payer: Hawaii Medical Service Association Medicare	$14,595.01
Rate for Payer: Humana Medicare	$14,595.01
Rate for Payer: Kaiser Permanente Medicare	$14,595.01
Rate for Payer: Ohana Health Plan Medicare	$14,595.01
Rate for Payer: UnitedHealthcare Medicare	$14,595.01

DIABETES WITHOUT CC/MCC

Facility

$14,813.75

Service Code	MSDRG 639
Min. Negotiated Rate	$6,557.97
Max. Negotiated Rate	$14,813.75
Rate for Payer: AlohaCare Medicare	$6,557.97
Rate for Payer: Hawaii Medical Service Association Commercial	$14,813.75
Rate for Payer: Hawaii Medical Service Association Medicare	$6,557.97
Rate for Payer: Humana Medicare	$6,557.97
Rate for Payer: Kaiser Permanente Medicare	$6,557.97
Rate for Payer: Ohana Health Plan Medicare	$6,557.97
Rate for Payer: UnitedHealthcare Medicare	$6,557.97

DIGESTIVE MALIGNANCY WITH CC

Facility

$54,633.11

Service Code	MSDRG 375
Min. Negotiated Rate	$12,356.87
Max. Negotiated Rate	$54,633.11
Rate for Payer: AlohaCare Medicare	$12,356.87
Rate for Payer: Hawaii Medical Service Association Commercial	$54,633.11
Rate for Payer: Hawaii Medical Service Association Medicare	$12,356.87
Rate for Payer: Humana Medicare	$12,356.87
Rate for Payer: Kaiser Permanente Medicare	$12,356.87
Rate for Payer: Ohana Health Plan Medicare	$12,356.87
Rate for Payer: UnitedHealthcare Medicare	$12,356.87

DIGESTIVE MALIGNANCY WITH MCC

Facility

$55,936.72

Service Code	MSDRG 374
Min. Negotiated Rate	$21,513.48
Max. Negotiated Rate	$55,936.72
Rate for Payer: AlohaCare Medicare	$21,513.48
Rate for Payer: Hawaii Medical Service Association Commercial	$55,936.72
Rate for Payer: Hawaii Medical Service Association Medicare	$21,513.48
Rate for Payer: Humana Medicare	$21,513.48
Rate for Payer: Kaiser Permanente Medicare	$21,513.48
Rate for Payer: Ohana Health Plan Medicare	$21,513.48
Rate for Payer: UnitedHealthcare Medicare	$21,513.48

Know your out-of-pocket cost for care.

All Charges