Leahi Hospital

All Charges

Charge

Type

Setting

Price

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$30,291.16

Service Code	MSDRG 983
Min. Negotiated Rate	$17,327.91
Max. Negotiated Rate	$30,291.16
Rate for Payer: AlohaCare Medicare	$17,327.91
Rate for Payer: Hawaii Medical Service Association Commercial	$30,291.16
Rate for Payer: Hawaii Medical Service Association Medicare	$17,327.91
Rate for Payer: Humana Medicare	$17,327.91
Rate for Payer: Kaiser Permanente Medicare	$17,327.91
Rate for Payer: Ohana Health Plan Medicare	$17,327.91
Rate for Payer: UnitedHealthcare Medicare	$17,327.91

EXTRACRANIAL PROCEDURES WITH CC

Facility

$54,135.37

Service Code	MSDRG 038
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$54,135.37
Rate for Payer: AlohaCare Medicare	$16,427.13
Rate for Payer: Hawaii Medical Service Association Commercial	$54,135.37
Rate for Payer: Hawaii Medical Service Association Medicare	$16,427.13
Rate for Payer: Humana Medicare	$16,427.13
Rate for Payer: Kaiser Permanente Medicare	$16,427.13
Rate for Payer: Ohana Health Plan Medicare	$16,427.13
Rate for Payer: UnitedHealthcare Medicare	$16,427.13
Rate for Payer: University Health Alliance Commercial	$10,400.00

EXTRACRANIAL PROCEDURES WITH MCC

Facility

$65,038.29

Service Code	MSDRG 037
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$65,038.29
Rate for Payer: AlohaCare Medicare	$32,880.66
Rate for Payer: Hawaii Medical Service Association Commercial	$65,038.29
Rate for Payer: Hawaii Medical Service Association Medicare	$32,880.66
Rate for Payer: Humana Medicare	$32,880.66
Rate for Payer: Kaiser Permanente Medicare	$32,880.66
Rate for Payer: Ohana Health Plan Medicare	$32,880.66
Rate for Payer: UnitedHealthcare Medicare	$32,880.66
Rate for Payer: University Health Alliance Commercial	$10,400.00

EXTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$42,142.16

Service Code	MSDRG 039
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$42,142.16
Rate for Payer: AlohaCare Medicare	$12,020.79
Rate for Payer: Hawaii Medical Service Association Commercial	$42,142.16
Rate for Payer: Hawaii Medical Service Association Medicare	$12,020.79
Rate for Payer: Humana Medicare	$12,020.79
Rate for Payer: Kaiser Permanente Medicare	$12,020.79
Rate for Payer: Ohana Health Plan Medicare	$12,020.79
Rate for Payer: UnitedHealthcare Medicare	$12,020.79
Rate for Payer: University Health Alliance Commercial	$10,400.00

EXTRAOCULAR PROCEDURES EXCEPT ORBIT

Facility

$17,800.20

Service Code	MSDRG 115
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$17,800.20
Rate for Payer: AlohaCare Medicare	$15,562.81
Rate for Payer: Hawaii Medical Service Association Commercial	$17,800.20
Rate for Payer: Hawaii Medical Service Association Medicare	$15,562.81
Rate for Payer: Humana Medicare	$15,562.81
Rate for Payer: Kaiser Permanente Medicare	$15,562.81
Rate for Payer: Ohana Health Plan Medicare	$15,562.81
Rate for Payer: UnitedHealthcare Medicare	$15,562.81
Rate for Payer: University Health Alliance Commercial	$10,400.00

EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE

Facility

$271,980.45

Service Code	MSDRG 790
Min. Negotiated Rate	$59,011.15
Max. Negotiated Rate	$271,980.45
Rate for Payer: AlohaCare Medicare	$59,011.15
Rate for Payer: Hawaii Medical Service Association Commercial	$271,980.45
Rate for Payer: Hawaii Medical Service Association Medicare	$59,011.15
Rate for Payer: Humana Medicare	$59,011.15
Rate for Payer: Kaiser Permanente Medicare	$59,011.15
Rate for Payer: Ohana Health Plan Medicare	$59,011.15
Rate for Payer: UnitedHealthcare Medicare	$59,011.15

FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

$18,203.14

Service Code	MSDRG 748
Min. Negotiated Rate	$14,108.16
Max. Negotiated Rate	$18,203.14
Rate for Payer: AlohaCare Medicare	$14,108.16
Rate for Payer: Hawaii Medical Service Association Commercial	$18,203.14
Rate for Payer: Hawaii Medical Service Association Medicare	$14,108.16
Rate for Payer: Humana Medicare	$14,108.16
Rate for Payer: Kaiser Permanente Medicare	$14,108.16
Rate for Payer: Ohana Health Plan Medicare	$14,108.16
Rate for Payer: UnitedHealthcare Medicare	$14,108.16

Ferritin

Facility

$244.00

Service Code	HCPCS 82728
Hospital Charge Code	82728
Hospital Revenue Code	301
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$236.68
Rate for Payer: AlohaCare Medicaid	$122.00
Rate for Payer: Cash Price	$158.60
Rate for Payer: Cash Price	$158.60
Rate for Payer: Hawaii Medical Service Association ABD	$15.81
Rate for Payer: Hawaii Medical Service Association Commercial	$17.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.60
Rate for Payer: Hawaii Western Management Group Commercial	$13.63
Rate for Payer: Health Management Network Commercial	$207.40
Rate for Payer: Kaiser Permanente Commercial	$219.60
Rate for Payer: Kaiser Permanente Medicaid	$124.44
Rate for Payer: MDX Hawaii PPO	$236.68
Rate for Payer: UnitedHealthcare Medicaid	$15.81
Rate for Payer: University Health Alliance Commercial	$29.56

Ferritin

Facility

$244.00

Service Code	HCPCS 82728
Hospital Charge Code	82728
Hospital Revenue Code	301
Min. Negotiated Rate	$207.40
Max. Negotiated Rate	$236.68
Rate for Payer: Cash Price	$158.60
Rate for Payer: Health Management Network Commercial	$207.40
Rate for Payer: Kaiser Permanente Commercial	$219.60
Rate for Payer: MDX Hawaii PPO	$236.68

FEVER AND INFLAMMATORY CONDITIONS

Facility

$22,564.30

Service Code	MSDRG 864
Min. Negotiated Rate	$9,184.43
Max. Negotiated Rate	$22,564.30
Rate for Payer: AlohaCare Medicare	$9,184.43
Rate for Payer: Hawaii Medical Service Association Commercial	$22,564.30
Rate for Payer: Hawaii Medical Service Association Medicare	$9,184.43
Rate for Payer: Humana Medicare	$9,184.43
Rate for Payer: Kaiser Permanente Medicare	$9,184.43
Rate for Payer: Ohana Health Plan Medicare	$9,184.43
Rate for Payer: UnitedHealthcare Medicare	$9,184.43

Flucelvax Trivalent Preservative Free; Fluzone High-Dose Trivalent Preservative Free

Facility

$74.50

Service Code	HCPCS 90661
Hospital Charge Code	FLU-VAX
Hospital Revenue Code	636
Min. Negotiated Rate	$63.33
Max. Negotiated Rate	$72.27
Rate for Payer: Cash Price	$48.42
Rate for Payer: Health Management Network Commercial	$63.33
Rate for Payer: Kaiser Permanente Commercial	$67.05
Rate for Payer: MDX Hawaii PPO	$72.27

Flucelvax Trivalent Preservative Free; Fluzone High-Dose Trivalent Preservative Free

Facility

$74.50

Service Code	HCPCS 90661
Hospital Charge Code	FLU-VAX
Hospital Revenue Code	636
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$72.27
Rate for Payer: AlohaCare Medicaid	$37.25
Rate for Payer: Cash Price	$48.42
Rate for Payer: Cash Price	$48.42
Rate for Payer: Hawaii Medical Service Association ABD	$36.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.85
Rate for Payer: Hawaii Western Management Group Commercial	$70.78
Rate for Payer: Health Management Network Commercial	$63.33
Rate for Payer: Kaiser Permanente Commercial	$67.05
Rate for Payer: Kaiser Permanente Medicaid	$37.99
Rate for Payer: MDX Hawaii PPO	$72.27
Rate for Payer: UnitedHealthcare Medicaid	$44.70
Rate for Payer: University Health Alliance Commercial	$54.30

Folate

Facility

$250.00

Service Code	HCPCS 82746
Hospital Charge Code	82746
Hospital Revenue Code	301
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$242.50
Rate for Payer: AlohaCare Medicaid	$125.00
Rate for Payer: Cash Price	$162.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Hawaii Medical Service Association ABD	$20.32
Rate for Payer: Hawaii Medical Service Association Commercial	$18.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.34
Rate for Payer: Hawaii Western Management Group Commercial	$14.70
Rate for Payer: Health Management Network Commercial	$212.50
Rate for Payer: Kaiser Permanente Commercial	$225.00
Rate for Payer: Kaiser Permanente Medicaid	$127.50
Rate for Payer: MDX Hawaii PPO	$242.50
Rate for Payer: UnitedHealthcare Medicaid	$20.32
Rate for Payer: University Health Alliance Commercial	$38.00

Folate

Facility

$250.00

Service Code	HCPCS 82746
Hospital Charge Code	82746
Hospital Revenue Code	301
Min. Negotiated Rate	$212.50
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Health Management Network Commercial	$212.50
Rate for Payer: Kaiser Permanente Commercial	$225.00
Rate for Payer: MDX Hawaii PPO	$242.50

FOOT PROCEDURES WITH CC

Facility

$23,227.96

Service Code	MSDRG 504
Min. Negotiated Rate	$18,857.46
Max. Negotiated Rate	$23,227.96
Rate for Payer: AlohaCare Medicare	$18,857.46
Rate for Payer: Hawaii Medical Service Association Commercial	$23,227.96
Rate for Payer: Hawaii Medical Service Association Medicare	$18,857.46
Rate for Payer: Humana Medicare	$18,857.46
Rate for Payer: Kaiser Permanente Medicare	$18,857.46
Rate for Payer: Ohana Health Plan Medicare	$18,857.46
Rate for Payer: UnitedHealthcare Medicare	$18,857.46

FOOT PROCEDURES WITH MCC

Facility

$27,943.11

Service Code	MSDRG 503
Min. Negotiated Rate	$23,227.96
Max. Negotiated Rate	$27,943.11
Rate for Payer: AlohaCare Medicare	$27,943.11
Rate for Payer: Hawaii Medical Service Association Commercial	$23,227.96
Rate for Payer: Hawaii Medical Service Association Medicare	$27,943.11
Rate for Payer: Humana Medicare	$27,943.11
Rate for Payer: Kaiser Permanente Medicare	$27,943.11
Rate for Payer: Ohana Health Plan Medicare	$27,943.11
Rate for Payer: UnitedHealthcare Medicare	$27,943.11

FOOT PROCEDURES WITHOUT CC/MCC

Facility

$23,227.96

Service Code	MSDRG 505
Min. Negotiated Rate	$18,104.51
Max. Negotiated Rate	$23,227.96
Rate for Payer: AlohaCare Medicare	$18,104.51
Rate for Payer: Hawaii Medical Service Association Commercial	$23,227.96
Rate for Payer: Hawaii Medical Service Association Medicare	$18,104.51
Rate for Payer: Humana Medicare	$18,104.51
Rate for Payer: Kaiser Permanente Medicare	$18,104.51
Rate for Payer: Ohana Health Plan Medicare	$18,104.51
Rate for Payer: UnitedHealthcare Medicare	$18,104.51

FRACTURES OF FEMUR WITH MCC

Facility

$15,886.07

Service Code	MSDRG 533
Min. Negotiated Rate	$12,182.83
Max. Negotiated Rate	$15,886.07
Rate for Payer: AlohaCare Medicare	$15,886.07
Rate for Payer: Hawaii Medical Service Association Commercial	$12,182.83
Rate for Payer: Hawaii Medical Service Association Medicare	$15,886.07
Rate for Payer: Humana Medicare	$15,886.07
Rate for Payer: Kaiser Permanente Medicare	$15,886.07
Rate for Payer: Ohana Health Plan Medicare	$15,886.07
Rate for Payer: UnitedHealthcare Medicare	$15,886.07

FRACTURES OF FEMUR WITHOUT MCC

Facility

$12,182.83

Service Code	MSDRG 534
Min. Negotiated Rate	$8,380.23
Max. Negotiated Rate	$12,182.83
Rate for Payer: AlohaCare Medicare	$8,380.23
Rate for Payer: Hawaii Medical Service Association Commercial	$12,182.83
Rate for Payer: Hawaii Medical Service Association Medicare	$8,380.23
Rate for Payer: Humana Medicare	$8,380.23
Rate for Payer: Kaiser Permanente Medicare	$8,380.23
Rate for Payer: Ohana Health Plan Medicare	$8,380.23
Rate for Payer: UnitedHealthcare Medicare	$8,380.23

FRACTURES OF HIP AND PELVIS WITH MCC

Facility

$17,444.67

Service Code	MSDRG 535
Min. Negotiated Rate	$13,070.40
Max. Negotiated Rate	$17,444.67
Rate for Payer: AlohaCare Medicare	$13,070.40
Rate for Payer: Hawaii Medical Service Association Commercial	$17,444.67
Rate for Payer: Hawaii Medical Service Association Medicare	$13,070.40
Rate for Payer: Humana Medicare	$13,070.40
Rate for Payer: Kaiser Permanente Medicare	$13,070.40
Rate for Payer: Ohana Health Plan Medicare	$13,070.40
Rate for Payer: UnitedHealthcare Medicare	$13,070.40

FRACTURES OF HIP AND PELVIS WITHOUT MCC

Facility

$17,444.67

Service Code	MSDRG 536
Min. Negotiated Rate	$8,395.01
Max. Negotiated Rate	$17,444.67
Rate for Payer: AlohaCare Medicare	$8,395.01
Rate for Payer: Hawaii Medical Service Association Commercial	$17,444.67
Rate for Payer: Hawaii Medical Service Association Medicare	$8,395.01
Rate for Payer: Humana Medicare	$8,395.01
Rate for Payer: Kaiser Permanente Medicare	$8,395.01
Rate for Payer: Ohana Health Plan Medicare	$8,395.01
Rate for Payer: UnitedHealthcare Medicare	$8,395.01

FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC

Facility

$14,477.74

Service Code	MSDRG 562
Min. Negotiated Rate	$13,154.61
Max. Negotiated Rate	$14,477.74
Rate for Payer: AlohaCare Medicare	$14,477.74
Rate for Payer: Hawaii Medical Service Association Commercial	$13,154.61
Rate for Payer: Hawaii Medical Service Association Medicare	$14,477.74
Rate for Payer: Humana Medicare	$14,477.74
Rate for Payer: Kaiser Permanente Medicare	$14,477.74
Rate for Payer: Ohana Health Plan Medicare	$14,477.74
Rate for Payer: UnitedHealthcare Medicare	$14,477.74

FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC

Facility

$13,154.61

Service Code	MSDRG 563
Min. Negotiated Rate	$9,261.31
Max. Negotiated Rate	$13,154.61
Rate for Payer: AlohaCare Medicare	$9,261.31
Rate for Payer: Hawaii Medical Service Association Commercial	$13,154.61
Rate for Payer: Hawaii Medical Service Association Medicare	$9,261.31
Rate for Payer: Humana Medicare	$9,261.31
Rate for Payer: Kaiser Permanente Medicare	$9,261.31
Rate for Payer: Ohana Health Plan Medicare	$9,261.31
Rate for Payer: UnitedHealthcare Medicare	$9,261.31

FULL TERM NEONATE WITH MAJOR PROBLEMS

Facility

$41,528.73

Service Code	MSDRG 793
Min. Negotiated Rate	$18,985.30
Max. Negotiated Rate	$41,528.73
Rate for Payer: AlohaCare Medicare	$41,528.73
Rate for Payer: Hawaii Medical Service Association Commercial	$18,985.30
Rate for Payer: Hawaii Medical Service Association Medicare	$41,528.73
Rate for Payer: Humana Medicare	$41,528.73
Rate for Payer: Kaiser Permanente Medicare	$41,528.73
Rate for Payer: Ohana Health Plan Medicare	$41,528.73
Rate for Payer: UnitedHealthcare Medicare	$41,528.73

FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY

Facility

$22,222.09

Service Code	MSDRG 934
Min. Negotiated Rate	$22,222.09
Max. Negotiated Rate	$22,222.09
Rate for Payer: AlohaCare Medicare	$22,222.09
Rate for Payer: Hawaii Medical Service Association Medicare	$22,222.09
Rate for Payer: Humana Medicare	$22,222.09
Rate for Payer: Kaiser Permanente Medicare	$22,222.09
Rate for Payer: Ohana Health Plan Medicare	$22,222.09
Rate for Payer: UnitedHealthcare Medicare	$22,222.09

Know your out-of-pocket cost for care.

All Charges