Leahi Hospital

All Charges

Charge

Type

Setting

Price

DIGESTIVE MALIGNANCY WITHOUT CC/MCC

Facility

$28,489.80

Service Code	MSDRG 376
Min. Negotiated Rate	$9,545.13
Max. Negotiated Rate	$28,489.80
Rate for Payer: AlohaCare Medicare	$9,545.13
Rate for Payer: Hawaii Medical Service Association Commercial	$28,489.80
Rate for Payer: Hawaii Medical Service Association Medicare	$9,545.13
Rate for Payer: Humana Medicare	$9,545.13
Rate for Payer: Kaiser Permanente Medicare	$9,545.13
Rate for Payer: Ohana Health Plan Medicare	$9,545.13
Rate for Payer: UnitedHealthcare Medicare	$9,545.13

DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC

Facility

$31,926.59

Service Code	MSDRG 442
Min. Negotiated Rate	$9,949.21
Max. Negotiated Rate	$31,926.59
Rate for Payer: AlohaCare Medicare	$9,949.21
Rate for Payer: Hawaii Medical Service Association Commercial	$31,926.59
Rate for Payer: Hawaii Medical Service Association Medicare	$9,949.21
Rate for Payer: Humana Medicare	$9,949.21
Rate for Payer: Kaiser Permanente Medicare	$9,949.21
Rate for Payer: Ohana Health Plan Medicare	$9,949.21
Rate for Payer: UnitedHealthcare Medicare	$9,949.21

DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC

Facility

$31,926.59

Service Code	MSDRG 441
Min. Negotiated Rate	$18,123.24
Max. Negotiated Rate	$31,926.59
Rate for Payer: AlohaCare Medicare	$18,123.24
Rate for Payer: Hawaii Medical Service Association Commercial	$31,926.59
Rate for Payer: Hawaii Medical Service Association Medicare	$18,123.24
Rate for Payer: Humana Medicare	$18,123.24
Rate for Payer: Kaiser Permanente Medicare	$18,123.24
Rate for Payer: Ohana Health Plan Medicare	$18,123.24
Rate for Payer: UnitedHealthcare Medicare	$18,123.24

DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$23,085.75

Service Code	MSDRG 443
Min. Negotiated Rate	$7,331.62
Max. Negotiated Rate	$23,085.75
Rate for Payer: AlohaCare Medicare	$7,331.62
Rate for Payer: Hawaii Medical Service Association Commercial	$23,085.75
Rate for Payer: Hawaii Medical Service Association Medicare	$7,331.62
Rate for Payer: Humana Medicare	$7,331.62
Rate for Payer: Kaiser Permanente Medicare	$7,331.62
Rate for Payer: Ohana Health Plan Medicare	$7,331.62
Rate for Payer: UnitedHealthcare Medicare	$7,331.62

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC

Facility

$24,958.21

Service Code	MSDRG 439
Min. Negotiated Rate	$8,726.14
Max. Negotiated Rate	$24,958.21
Rate for Payer: AlohaCare Medicare	$8,726.14
Rate for Payer: Hawaii Medical Service Association Commercial	$24,958.21
Rate for Payer: Hawaii Medical Service Association Medicare	$8,726.14
Rate for Payer: Humana Medicare	$8,726.14
Rate for Payer: Kaiser Permanente Medicare	$8,726.14
Rate for Payer: Ohana Health Plan Medicare	$8,726.14
Rate for Payer: UnitedHealthcare Medicare	$8,726.14

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC

Facility

$24,958.21

Service Code	MSDRG 438
Min. Negotiated Rate	$16,502.04
Max. Negotiated Rate	$24,958.21
Rate for Payer: AlohaCare Medicare	$16,502.04
Rate for Payer: Hawaii Medical Service Association Commercial	$24,958.21
Rate for Payer: Hawaii Medical Service Association Medicare	$16,502.04
Rate for Payer: Humana Medicare	$16,502.04
Rate for Payer: Kaiser Permanente Medicare	$16,502.04
Rate for Payer: Ohana Health Plan Medicare	$16,502.04
Rate for Payer: UnitedHealthcare Medicare	$16,502.04

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$24,958.21

Service Code	MSDRG 440
Min. Negotiated Rate	$6,559.96
Max. Negotiated Rate	$24,958.21
Rate for Payer: AlohaCare Medicare	$6,559.96
Rate for Payer: Hawaii Medical Service Association Commercial	$24,958.21
Rate for Payer: Hawaii Medical Service Association Medicare	$6,559.96
Rate for Payer: Humana Medicare	$6,559.96
Rate for Payer: Kaiser Permanente Medicare	$6,559.96
Rate for Payer: Ohana Health Plan Medicare	$6,559.96
Rate for Payer: UnitedHealthcare Medicare	$6,559.96

DISORDERS OF PERSONALITY AND IMPULSE CONTROL

Facility

$21,118.48

Service Code	MSDRG 883
Min. Negotiated Rate	$19,814.42
Max. Negotiated Rate	$21,118.48
Rate for Payer: AlohaCare Medicare	$19,814.42
Rate for Payer: Hawaii Medical Service Association Commercial	$21,118.48
Rate for Payer: Hawaii Medical Service Association Medicare	$19,814.42
Rate for Payer: Humana Medicare	$19,814.42
Rate for Payer: Kaiser Permanente Medicare	$19,814.42
Rate for Payer: Ohana Health Plan Medicare	$19,814.42
Rate for Payer: UnitedHealthcare Medicare	$19,814.42

DISORDERS OF THE BILIARY TRACT WITH CC

Facility

$25,124.12

Service Code	MSDRG 445
Min. Negotiated Rate	$11,221.52
Max. Negotiated Rate	$25,124.12
Rate for Payer: AlohaCare Medicare	$11,221.52
Rate for Payer: Hawaii Medical Service Association Commercial	$25,124.12
Rate for Payer: Hawaii Medical Service Association Medicare	$11,221.52
Rate for Payer: Humana Medicare	$11,221.52
Rate for Payer: Kaiser Permanente Medicare	$11,221.52
Rate for Payer: Ohana Health Plan Medicare	$11,221.52
Rate for Payer: UnitedHealthcare Medicare	$11,221.52

DISORDERS OF THE BILIARY TRACT WITH MCC

Facility

$25,645.56

Service Code	MSDRG 444
Min. Negotiated Rate	$16,903.14
Max. Negotiated Rate	$25,645.56
Rate for Payer: AlohaCare Medicare	$16,903.14
Rate for Payer: Hawaii Medical Service Association Commercial	$25,645.56
Rate for Payer: Hawaii Medical Service Association Medicare	$16,903.14
Rate for Payer: Humana Medicare	$16,903.14
Rate for Payer: Kaiser Permanente Medicare	$16,903.14
Rate for Payer: Ohana Health Plan Medicare	$16,903.14
Rate for Payer: UnitedHealthcare Medicare	$16,903.14

DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC

Facility

$16,567.70

Service Code	MSDRG 446
Min. Negotiated Rate	$8,589.17
Max. Negotiated Rate	$16,567.70
Rate for Payer: AlohaCare Medicare	$8,589.17
Rate for Payer: Hawaii Medical Service Association Commercial	$16,567.70
Rate for Payer: Hawaii Medical Service Association Medicare	$8,589.17
Rate for Payer: Humana Medicare	$8,589.17
Rate for Payer: Kaiser Permanente Medicare	$8,589.17
Rate for Payer: Ohana Health Plan Medicare	$8,589.17
Rate for Payer: UnitedHealthcare Medicare	$8,589.17

DYSEQUILIBRIUM

Facility

$12,727.97

Service Code	MSDRG 149
Min. Negotiated Rate	$7,843.11
Max. Negotiated Rate	$12,727.97
Rate for Payer: AlohaCare Medicare	$7,843.11
Rate for Payer: Hawaii Medical Service Association Commercial	$12,727.97
Rate for Payer: Hawaii Medical Service Association Medicare	$7,843.11
Rate for Payer: Humana Medicare	$7,843.11
Rate for Payer: Kaiser Permanente Medicare	$7,843.11
Rate for Payer: Ohana Health Plan Medicare	$7,843.11
Rate for Payer: UnitedHealthcare Medicare	$7,843.11

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC

Facility

$35,363.38

Service Code	MSDRG 147
Min. Negotiated Rate	$12,966.91
Max. Negotiated Rate	$35,363.38
Rate for Payer: AlohaCare Medicare	$12,966.91
Rate for Payer: Hawaii Medical Service Association Commercial	$35,363.38
Rate for Payer: Hawaii Medical Service Association Medicare	$12,966.91
Rate for Payer: Humana Medicare	$12,966.91
Rate for Payer: Kaiser Permanente Medicare	$12,966.91
Rate for Payer: Ohana Health Plan Medicare	$12,966.91
Rate for Payer: UnitedHealthcare Medicare	$12,966.91

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC

Facility

$35,363.38

Service Code	MSDRG 146
Min. Negotiated Rate	$21,303.57
Max. Negotiated Rate	$35,363.38
Rate for Payer: AlohaCare Medicare	$21,303.57
Rate for Payer: Hawaii Medical Service Association Commercial	$35,363.38
Rate for Payer: Hawaii Medical Service Association Medicare	$21,303.57
Rate for Payer: Humana Medicare	$21,303.57
Rate for Payer: Kaiser Permanente Medicare	$21,303.57
Rate for Payer: Ohana Health Plan Medicare	$21,303.57
Rate for Payer: UnitedHealthcare Medicare	$21,303.57

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC

Facility

$35,363.38

Service Code	MSDRG 148
Min. Negotiated Rate	$8,291.53
Max. Negotiated Rate	$35,363.38
Rate for Payer: AlohaCare Medicare	$8,291.53
Rate for Payer: Hawaii Medical Service Association Commercial	$35,363.38
Rate for Payer: Hawaii Medical Service Association Medicare	$8,291.53
Rate for Payer: Humana Medicare	$8,291.53
Rate for Payer: Kaiser Permanente Medicare	$8,291.53
Rate for Payer: Ohana Health Plan Medicare	$8,291.53
Rate for Payer: UnitedHealthcare Medicare	$8,291.53

ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES

Facility

$466,787.19

Service Code	MSDRG 003
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$466,787.19
Rate for Payer: AlohaCare Medicare	$209,617.78
Rate for Payer: Hawaii Medical Service Association Commercial	$466,787.19
Rate for Payer: Hawaii Medical Service Association Medicare	$209,617.78
Rate for Payer: Humana Medicare	$209,617.78
Rate for Payer: Kaiser Permanente Medicare	$209,617.78
Rate for Payer: Ohana Health Plan Medicare	$209,617.78
Rate for Payer: UnitedHealthcare Medicare	$209,617.78
Rate for Payer: University Health Alliance Commercial	$10,400.00

Elbow/wrist strapping

Facility

$467.00

Service Code	HCPCS 29260 GO
Hospital Charge Code	OT29260
Hospital Revenue Code	430
Min. Negotiated Rate	$396.95
Max. Negotiated Rate	$452.99
Rate for Payer: Cash Price	$303.55
Rate for Payer: Health Management Network Commercial	$396.95
Rate for Payer: Kaiser Permanente Commercial	$420.30
Rate for Payer: MDX Hawaii PPO	$452.99

Elbow/wrist strapping

Facility

$467.00

Service Code	HCPCS 29260 GO
Hospital Charge Code	OT29260
Hospital Revenue Code	430
Min. Negotiated Rate	$21.56
Max. Negotiated Rate	$452.99
Rate for Payer: AlohaCare Medicaid	$233.50
Rate for Payer: Cash Price	$303.55
Rate for Payer: Cash Price	$303.55
Rate for Payer: Hawaii Western Management Group Commercial	$443.65
Rate for Payer: Health Management Network Commercial	$396.95
Rate for Payer: Kaiser Permanente Commercial	$420.30
Rate for Payer: Kaiser Permanente Medicaid	$238.17
Rate for Payer: MDX Hawaii PPO	$452.99
Rate for Payer: UnitedHealthcare Medicaid	$21.56
Rate for Payer: University Health Alliance Commercial	$340.40

Elec stim 15 min c. att.

Facility

$118.00

Service Code	HCPCS 97032 GO
Hospital Charge Code	OT97032
Hospital Revenue Code	430
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$76.70
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: MDX Hawaii PPO	$114.46

Elec stim 15 min c. att.

Facility

$118.00

Service Code	HCPCS 97032 GO
Hospital Charge Code	OT97032
Hospital Revenue Code	430
Min. Negotiated Rate	$13.64
Max. Negotiated Rate	$114.46
Rate for Payer: AlohaCare Medicaid	$59.00
Rate for Payer: Cash Price	$76.70
Rate for Payer: Cash Price	$76.70
Rate for Payer: Hawaii Western Management Group Commercial	$112.10
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: Kaiser Permanente Medicaid	$60.18
Rate for Payer: MDX Hawaii PPO	$114.46
Rate for Payer: UnitedHealthcare Medicaid	$13.64
Rate for Payer: University Health Alliance Commercial	$86.01

Elec stim ca 15 min

Facility

$118.00

Service Code	HCPCS 97032 GP
Hospital Charge Code	PT97032
Hospital Revenue Code	420
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$76.70
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: MDX Hawaii PPO	$114.46

Elec stim ca 15 min

Facility

$118.00

Service Code	HCPCS 97032 GP
Hospital Charge Code	PT97032
Hospital Revenue Code	420
Min. Negotiated Rate	$13.64
Max. Negotiated Rate	$114.46
Rate for Payer: AlohaCare Medicaid	$59.00
Rate for Payer: Cash Price	$76.70
Rate for Payer: Cash Price	$76.70
Rate for Payer: Hawaii Western Management Group Commercial	$112.10
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: Kaiser Permanente Medicaid	$60.18
Rate for Payer: MDX Hawaii PPO	$114.46
Rate for Payer: UnitedHealthcare Medicaid	$13.64
Rate for Payer: University Health Alliance Commercial	$86.01

Elec stim stage iii/iv w

Facility

$106.00

Service Code	HCPCS G0281 GP
Hospital Charge Code	PTG0281
Hospital Revenue Code	420
Min. Negotiated Rate	$9.73
Max. Negotiated Rate	$102.82
Rate for Payer: AlohaCare Medicaid	$53.00
Rate for Payer: Cash Price	$68.90
Rate for Payer: Cash Price	$68.90
Rate for Payer: Hawaii Western Management Group Commercial	$100.70
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Kaiser Permanente Commercial	$95.40
Rate for Payer: Kaiser Permanente Medicaid	$54.06
Rate for Payer: MDX Hawaii PPO	$102.82
Rate for Payer: UnitedHealthcare Medicaid	$9.73
Rate for Payer: University Health Alliance Commercial	$77.26

Elec stim stage iii/iv w

Facility

$106.00

Service Code	HCPCS G0281 GP
Hospital Charge Code	PTG0281
Hospital Revenue Code	420
Min. Negotiated Rate	$90.10
Max. Negotiated Rate	$102.82
Rate for Payer: Cash Price	$68.90
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Kaiser Permanente Commercial	$95.40
Rate for Payer: MDX Hawaii PPO	$102.82

Elec stim stage iii/iv w

Facility

$106.00

Service Code	HCPCS G0281 GO
Hospital Charge Code	OTG0281
Hospital Revenue Code	430
Min. Negotiated Rate	$90.10
Max. Negotiated Rate	$102.82
Rate for Payer: Cash Price	$68.90
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Kaiser Permanente Commercial	$95.40
Rate for Payer: MDX Hawaii PPO	$102.82

Know your out-of-pocket cost for care.

All Charges