Leahi Hospital

All Charges

Charge

Type

Setting

Price

FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC

Facility

$71,125.35

Service Code	MSDRG 928
Min. Negotiated Rate	$71,125.35
Max. Negotiated Rate	$71,125.35
Rate for Payer: AlohaCare Medicare	$71,125.35
Rate for Payer: Hawaii Medical Service Association Medicare	$71,125.35
Rate for Payer: Humana Medicare	$71,125.35
Rate for Payer: Kaiser Permanente Medicare	$71,125.35
Rate for Payer: Ohana Health Plan Medicare	$71,125.35
Rate for Payer: UnitedHealthcare Medicare	$71,125.35

FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC

Facility

$32,177.97

Service Code	MSDRG 929
Min. Negotiated Rate	$32,177.97
Max. Negotiated Rate	$32,177.97
Rate for Payer: AlohaCare Medicare	$32,177.97
Rate for Payer: Hawaii Medical Service Association Medicare	$32,177.97
Rate for Payer: Humana Medicare	$32,177.97
Rate for Payer: Kaiser Permanente Medicare	$32,177.97
Rate for Payer: Ohana Health Plan Medicare	$32,177.97
Rate for Payer: UnitedHealthcare Medicare	$32,177.97

Gait training

Facility

$199.00

Service Code	HCPCS 97116 GP
Hospital Charge Code	PT97116
Hospital Revenue Code	420
Min. Negotiated Rate	$16.70
Max. Negotiated Rate	$193.03
Rate for Payer: AlohaCare Medicaid	$99.50
Rate for Payer: Cash Price	$129.35
Rate for Payer: Cash Price	$129.35
Rate for Payer: Hawaii Western Management Group Commercial	$189.05
Rate for Payer: Health Management Network Commercial	$169.15
Rate for Payer: Kaiser Permanente Commercial	$179.10
Rate for Payer: Kaiser Permanente Medicaid	$101.49
Rate for Payer: MDX Hawaii PPO	$193.03
Rate for Payer: UnitedHealthcare Medicaid	$16.70
Rate for Payer: University Health Alliance Commercial	$145.05

Gait training

Facility

$199.00

Service Code	HCPCS 97116 GP
Hospital Charge Code	PT97116
Hospital Revenue Code	420
Min. Negotiated Rate	$169.15
Max. Negotiated Rate	$193.03
Rate for Payer: Cash Price	$129.35
Rate for Payer: Health Management Network Commercial	$169.15
Rate for Payer: Kaiser Permanente Commercial	$179.10
Rate for Payer: MDX Hawaii PPO	$193.03

GASTROINTESTINAL HEMORRHAGE WITH CC

Facility

$21,355.50

Service Code	MSDRG 378
Min. Negotiated Rate	$10,100.98
Max. Negotiated Rate	$21,355.50
Rate for Payer: AlohaCare Medicare	$10,100.98
Rate for Payer: Hawaii Medical Service Association Commercial	$21,355.50
Rate for Payer: Hawaii Medical Service Association Medicare	$10,100.98
Rate for Payer: Humana Medicare	$10,100.98
Rate for Payer: Kaiser Permanente Medicare	$10,100.98
Rate for Payer: Ohana Health Plan Medicare	$10,100.98
Rate for Payer: UnitedHealthcare Medicare	$10,100.98

GASTROINTESTINAL HEMORRHAGE WITH MCC

Facility

$21,355.50

Service Code	MSDRG 377
Min. Negotiated Rate	$18,451.43
Max. Negotiated Rate	$21,355.50
Rate for Payer: AlohaCare Medicare	$18,451.43
Rate for Payer: Hawaii Medical Service Association Commercial	$21,355.50
Rate for Payer: Hawaii Medical Service Association Medicare	$18,451.43
Rate for Payer: Humana Medicare	$18,451.43
Rate for Payer: Kaiser Permanente Medicare	$18,451.43
Rate for Payer: Ohana Health Plan Medicare	$18,451.43
Rate for Payer: UnitedHealthcare Medicare	$18,451.43

GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC

Facility

$16,378.08

Service Code	MSDRG 379
Min. Negotiated Rate	$6,648.64
Max. Negotiated Rate	$16,378.08
Rate for Payer: AlohaCare Medicare	$6,648.64
Rate for Payer: Hawaii Medical Service Association Commercial	$16,378.08
Rate for Payer: Hawaii Medical Service Association Medicare	$6,648.64
Rate for Payer: Humana Medicare	$6,648.64
Rate for Payer: Kaiser Permanente Medicare	$6,648.64
Rate for Payer: Ohana Health Plan Medicare	$6,648.64
Rate for Payer: UnitedHealthcare Medicare	$6,648.64

GASTROINTESTINAL OBSTRUCTION WITH CC

Facility

$16,662.51

Service Code	MSDRG 389
Min. Negotiated Rate	$8,219.59
Max. Negotiated Rate	$16,662.51
Rate for Payer: AlohaCare Medicare	$8,219.59
Rate for Payer: Hawaii Medical Service Association Commercial	$16,662.51
Rate for Payer: Hawaii Medical Service Association Medicare	$8,219.59
Rate for Payer: Humana Medicare	$8,219.59
Rate for Payer: Kaiser Permanente Medicare	$8,219.59
Rate for Payer: Ohana Health Plan Medicare	$8,219.59
Rate for Payer: UnitedHealthcare Medicare	$8,219.59

GASTROINTESTINAL OBSTRUCTION WITH MCC

Facility

$18,771.98

Service Code	MSDRG 388
Min. Negotiated Rate	$14,990.23
Max. Negotiated Rate	$18,771.98
Rate for Payer: AlohaCare Medicare	$14,990.23
Rate for Payer: Hawaii Medical Service Association Commercial	$18,771.98
Rate for Payer: Hawaii Medical Service Association Medicare	$14,990.23
Rate for Payer: Humana Medicare	$14,990.23
Rate for Payer: Kaiser Permanente Medicare	$14,990.23
Rate for Payer: Ohana Health Plan Medicare	$14,990.23
Rate for Payer: UnitedHealthcare Medicare	$14,990.23

GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC

Facility

$13,273.12

Service Code	MSDRG 390
Min. Negotiated Rate	$5,797.14
Max. Negotiated Rate	$13,273.12
Rate for Payer: AlohaCare Medicare	$5,797.14
Rate for Payer: Hawaii Medical Service Association Commercial	$13,273.12
Rate for Payer: Hawaii Medical Service Association Medicare	$5,797.14
Rate for Payer: Humana Medicare	$5,797.14
Rate for Payer: Kaiser Permanente Medicare	$5,797.14
Rate for Payer: Ohana Health Plan Medicare	$5,797.14
Rate for Payer: UnitedHealthcare Medicare	$5,797.14

Gram stain

Facility

$82.00

Service Code	HCPCS 87025
Hospital Charge Code	87205
Hospital Revenue Code	306
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$79.54
Rate for Payer: AlohaCare Medicaid	$41.00
Rate for Payer: Cash Price	$53.30
Rate for Payer: Hawaii Western Management Group Commercial	$77.90
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: Kaiser Permanente Medicaid	$41.82
Rate for Payer: MDX Hawaii PPO	$79.54
Rate for Payer: University Health Alliance Commercial	$59.77

Gram stain

Facility

$82.00

Service Code	HCPCS 87025
Hospital Charge Code	87205
Hospital Revenue Code	306
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$53.30
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: MDX Hawaii PPO	$79.54

Group Therapeutic Procedures

Facility

$127.00

Service Code	HCPCS 97150 GO
Hospital Charge Code	OT97150
Hospital Revenue Code	430
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$82.55
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: MDX Hawaii PPO	$123.19

Group Therapeutic Procedures

Facility

$127.00

Service Code	HCPCS 97150 GO
Hospital Charge Code	OT97150
Hospital Revenue Code	430
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$123.19
Rate for Payer: AlohaCare Medicaid	$63.50
Rate for Payer: Cash Price	$82.55
Rate for Payer: Cash Price	$82.55
Rate for Payer: Hawaii Western Management Group Commercial	$120.65
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: UnitedHealthcare Medicaid	$14.78
Rate for Payer: University Health Alliance Commercial	$92.57

Group Theraputic Procedures

Facility

$127.00

Service Code	HCPCS 97150 GP
Hospital Charge Code	PT97150
Hospital Revenue Code	420
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$123.19
Rate for Payer: AlohaCare Medicaid	$63.50
Rate for Payer: Cash Price	$82.55
Rate for Payer: Cash Price	$82.55
Rate for Payer: Hawaii Western Management Group Commercial	$120.65
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: UnitedHealthcare Medicaid	$14.78
Rate for Payer: University Health Alliance Commercial	$92.57

Group Theraputic Procedures

Facility

$127.00

Service Code	HCPCS 97150 GP
Hospital Charge Code	PT97150
Hospital Revenue Code	420
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$82.55
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: MDX Hawaii PPO	$123.19

Hand/finger strapping

Facility

$467.00

Service Code	HCPCS 29280 GO
Hospital Charge Code	OT29280
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

Hand/finger strapping

Facility

$467.00

Service Code	HCPCS 29280 GO
Hospital Charge Code	OT29280
Hospital Revenue Code	430
Min. Negotiated Rate	$20.29
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	$20.29
Rate for Payer: University Health Alliance Commercial	$340.40

HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC

Facility

$26,641.05

Service Code	MSDRG 513
Min. Negotiated Rate	$15,951.11
Max. Negotiated Rate	$26,641.05
Rate for Payer: AlohaCare Medicare	$15,951.11
Rate for Payer: Hawaii Medical Service Association Commercial	$26,641.05
Rate for Payer: Hawaii Medical Service Association Medicare	$15,951.11
Rate for Payer: Humana Medicare	$15,951.11
Rate for Payer: Kaiser Permanente Medicare	$15,951.11
Rate for Payer: Ohana Health Plan Medicare	$15,951.11
Rate for Payer: UnitedHealthcare Medicare	$15,951.11

HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$18,416.45

Service Code	MSDRG 514
Min. Negotiated Rate	$10,510.96
Max. Negotiated Rate	$18,416.45
Rate for Payer: AlohaCare Medicare	$10,510.96
Rate for Payer: Hawaii Medical Service Association Commercial	$18,416.45
Rate for Payer: Hawaii Medical Service Association Medicare	$10,510.96
Rate for Payer: Humana Medicare	$10,510.96
Rate for Payer: Kaiser Permanente Medicare	$10,510.96
Rate for Payer: Ohana Health Plan Medicare	$10,510.96
Rate for Payer: UnitedHealthcare Medicare	$10,510.96

HAND PROCEDURES FOR INJURIES

Facility

$22,161.37

Service Code	MSDRG 906
Min. Negotiated Rate	$19,794.70
Max. Negotiated Rate	$22,161.37
Rate for Payer: AlohaCare Medicare	$19,794.70
Rate for Payer: Hawaii Medical Service Association Commercial	$22,161.37
Rate for Payer: Hawaii Medical Service Association Medicare	$19,794.70
Rate for Payer: Humana Medicare	$19,794.70
Rate for Payer: Kaiser Permanente Medicare	$19,794.70
Rate for Payer: Ohana Health Plan Medicare	$19,794.70
Rate for Payer: UnitedHealthcare Medicare	$19,794.70

HEADACHES WITH MCC

Facility

$15,667.02

Service Code	MSDRG 102
Min. Negotiated Rate	$11,482.69
Max. Negotiated Rate	$15,667.02
Rate for Payer: AlohaCare Medicare	$11,482.69
Rate for Payer: Hawaii Medical Service Association Commercial	$15,667.02
Rate for Payer: Hawaii Medical Service Association Medicare	$11,482.69
Rate for Payer: Humana Medicare	$11,482.69
Rate for Payer: Kaiser Permanente Medicare	$11,482.69
Rate for Payer: Ohana Health Plan Medicare	$11,482.69
Rate for Payer: UnitedHealthcare Medicare	$11,482.69

HEADACHES WITHOUT MCC

Facility

$15,667.02

Service Code	MSDRG 103
Min. Negotiated Rate	$8,677.85
Max. Negotiated Rate	$15,667.02
Rate for Payer: AlohaCare Medicare	$8,677.85
Rate for Payer: Hawaii Medical Service Association Commercial	$15,667.02
Rate for Payer: Hawaii Medical Service Association Medicare	$8,677.85
Rate for Payer: Humana Medicare	$8,677.85
Rate for Payer: Kaiser Permanente Medicare	$8,677.85
Rate for Payer: Ohana Health Plan Medicare	$8,677.85
Rate for Payer: UnitedHealthcare Medicare	$8,677.85

HEART FAILURE AND SHOCK WITH CC

Facility

$28,513.51

Service Code	MSDRG 292
Min. Negotiated Rate	$8,803.03
Max. Negotiated Rate	$28,513.51
Rate for Payer: AlohaCare Medicare	$8,803.03
Rate for Payer: Hawaii Medical Service Association Commercial	$28,513.51
Rate for Payer: Hawaii Medical Service Association Medicare	$8,803.03
Rate for Payer: Humana Medicare	$8,803.03
Rate for Payer: Kaiser Permanente Medicare	$8,803.03
Rate for Payer: Ohana Health Plan Medicare	$8,803.03
Rate for Payer: UnitedHealthcare Medicare	$8,803.03

HEART FAILURE AND SHOCK WITH MCC

Facility

$28,513.51

Service Code	MSDRG 291
Min. Negotiated Rate	$13,088.13
Max. Negotiated Rate	$28,513.51
Rate for Payer: AlohaCare Medicare	$13,088.13
Rate for Payer: Hawaii Medical Service Association Commercial	$28,513.51
Rate for Payer: Hawaii Medical Service Association Medicare	$13,088.13
Rate for Payer: Humana Medicare	$13,088.13
Rate for Payer: Kaiser Permanente Medicare	$13,088.13
Rate for Payer: Ohana Health Plan Medicare	$13,088.13
Rate for Payer: UnitedHealthcare Medicare	$13,088.13

Know your out-of-pocket cost for care.

All Charges