Leahi Hospital

All Charges

Charge

Type

Setting

Price

HIV WITH MAJOR RELATED CONDITION WITH MCC

Facility

$57,643.26

Service Code	MSDRG 974
Min. Negotiated Rate	$28,878.40
Max. Negotiated Rate	$57,643.26
Rate for Payer: AlohaCare Medicare	$28,878.40
Rate for Payer: Hawaii Medical Service Association Commercial	$57,643.26
Rate for Payer: Hawaii Medical Service Association Medicare	$28,878.40
Rate for Payer: Humana Medicare	$28,878.40
Rate for Payer: Kaiser Permanente Medicare	$28,878.40
Rate for Payer: Ohana Health Plan Medicare	$28,878.40
Rate for Payer: UnitedHealthcare Medicare	$28,878.40

HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC

Facility

$57,643.26

Service Code	MSDRG 976
Min. Negotiated Rate	$9,332.26
Max. Negotiated Rate	$57,643.26
Rate for Payer: AlohaCare Medicare	$9,332.26
Rate for Payer: Hawaii Medical Service Association Commercial	$57,643.26
Rate for Payer: Hawaii Medical Service Association Medicare	$9,332.26
Rate for Payer: Humana Medicare	$9,332.26
Rate for Payer: Kaiser Permanente Medicare	$9,332.26
Rate for Payer: Ohana Health Plan Medicare	$9,332.26
Rate for Payer: UnitedHealthcare Medicare	$9,332.26

HIV WITH OR WITHOUT OTHER RELATED CONDITION

Facility

$41,431.10

Service Code	MSDRG 977
Min. Negotiated Rate	$13,225.11
Max. Negotiated Rate	$41,431.10
Rate for Payer: AlohaCare Medicare	$13,225.11
Rate for Payer: Hawaii Medical Service Association Commercial	$41,431.10
Rate for Payer: Hawaii Medical Service Association Medicare	$13,225.11
Rate for Payer: Humana Medicare	$13,225.11
Rate for Payer: Kaiser Permanente Medicare	$13,225.11
Rate for Payer: Ohana Health Plan Medicare	$13,225.11
Rate for Payer: UnitedHealthcare Medicare	$13,225.11

HOMOCYSTINE

Facility

$288.00

Service Code	HCPCS 83090
Hospital Charge Code	83090
Hospital Revenue Code	301
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$279.36
Rate for Payer: Cash Price	$187.20
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: Kaiser Permanente Commercial	$259.20
Rate for Payer: MDX Hawaii PPO	$279.36

HOMOCYSTINE

Facility

$288.00

Service Code	HCPCS 83090
Hospital Charge Code	83090
Hospital Revenue Code	301
Min. Negotiated Rate	$17.92
Max. Negotiated Rate	$279.36
Rate for Payer: AlohaCare Medicaid	$144.00
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$187.20
Rate for Payer: Hawaii Medical Service Association ABD	$23.31
Rate for Payer: Hawaii Medical Service Association Commercial	$22.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.48
Rate for Payer: Hawaii Western Management Group Commercial	$17.92
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: Kaiser Permanente Commercial	$259.20
Rate for Payer: Kaiser Permanente Medicaid	$146.88
Rate for Payer: MDX Hawaii PPO	$279.36
Rate for Payer: UnitedHealthcare Medicaid	$23.31
Rate for Payer: University Health Alliance Commercial	$43.60

HYPERTENSION WITH MCC

Facility

$13,699.76

Service Code	MSDRG 304
Min. Negotiated Rate	$12,163.70
Max. Negotiated Rate	$13,699.76
Rate for Payer: AlohaCare Medicare	$12,163.70
Rate for Payer: Hawaii Medical Service Association Commercial	$13,699.76
Rate for Payer: Hawaii Medical Service Association Medicare	$12,163.70
Rate for Payer: Humana Medicare	$12,163.70
Rate for Payer: Kaiser Permanente Medicare	$12,163.70
Rate for Payer: Ohana Health Plan Medicare	$12,163.70
Rate for Payer: UnitedHealthcare Medicare	$12,163.70

HYPERTENSION WITHOUT MCC

Facility

$13,699.76

Service Code	MSDRG 305
Min. Negotiated Rate	$7,877.61
Max. Negotiated Rate	$13,699.76
Rate for Payer: AlohaCare Medicare	$7,877.61
Rate for Payer: Hawaii Medical Service Association Commercial	$13,699.76
Rate for Payer: Hawaii Medical Service Association Medicare	$7,877.61
Rate for Payer: Humana Medicare	$7,877.61
Rate for Payer: Kaiser Permanente Medicare	$7,877.61
Rate for Payer: Ohana Health Plan Medicare	$7,877.61
Rate for Payer: UnitedHealthcare Medicare	$7,877.61

Iiv adjuvant vaccine im

Facility

$147.50

Service Code	HCPCS 90653
Hospital Charge Code	FLUAD
Hospital Revenue Code	636
Min. Negotiated Rate	$73.75
Max. Negotiated Rate	$143.07
Rate for Payer: AlohaCare Medicaid	$73.75
Rate for Payer: Cash Price	$95.88
Rate for Payer: Cash Price	$95.88
Rate for Payer: Hawaii Medical Service Association ABD	$83.49
Rate for Payer: Hawaii Medical Service Association Non-ABD	$83.49
Rate for Payer: Hawaii Western Management Group Commercial	$140.12
Rate for Payer: Health Management Network Commercial	$125.38
Rate for Payer: Kaiser Permanente Commercial	$132.75
Rate for Payer: Kaiser Permanente Medicaid	$75.22
Rate for Payer: MDX Hawaii PPO	$143.07
Rate for Payer: UnitedHealthcare Medicaid	$88.50
Rate for Payer: University Health Alliance Commercial	$107.51

Iiv adjuvant vaccine im

Facility

$147.50

Service Code	HCPCS 90653
Hospital Charge Code	FLUAD
Hospital Revenue Code	636
Min. Negotiated Rate	$125.38
Max. Negotiated Rate	$143.07
Rate for Payer: Cash Price	$95.88
Rate for Payer: Health Management Network Commercial	$125.38
Rate for Payer: Kaiser Permanente Commercial	$132.75
Rate for Payer: MDX Hawaii PPO	$143.07

INBORN AND OTHER DISORDERS OF METABOLISM

Facility

$85,327.20

Service Code	MSDRG 642
Min. Negotiated Rate	$14,451.14
Max. Negotiated Rate	$85,327.20
Rate for Payer: AlohaCare Medicare	$14,451.14
Rate for Payer: Hawaii Medical Service Association Commercial	$85,327.20
Rate for Payer: Hawaii Medical Service Association Medicare	$14,451.14
Rate for Payer: Humana Medicare	$14,451.14
Rate for Payer: Kaiser Permanente Medicare	$14,451.14
Rate for Payer: Ohana Health Plan Medicare	$14,451.14
Rate for Payer: UnitedHealthcare Medicare	$14,451.14

INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC

Facility

$13,652.35

Service Code	MSDRG 758
Min. Negotiated Rate	$10,084.22
Max. Negotiated Rate	$13,652.35
Rate for Payer: AlohaCare Medicare	$10,084.22
Rate for Payer: Hawaii Medical Service Association Commercial	$13,652.35
Rate for Payer: Hawaii Medical Service Association Medicare	$10,084.22
Rate for Payer: Humana Medicare	$10,084.22
Rate for Payer: Kaiser Permanente Medicare	$10,084.22
Rate for Payer: Ohana Health Plan Medicare	$10,084.22
Rate for Payer: UnitedHealthcare Medicare	$10,084.22

INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$14,547.70

Service Code	MSDRG 757
Min. Negotiated Rate	$13,652.35
Max. Negotiated Rate	$14,547.70
Rate for Payer: AlohaCare Medicare	$14,547.70
Rate for Payer: Hawaii Medical Service Association Commercial	$13,652.35
Rate for Payer: Hawaii Medical Service Association Medicare	$14,547.70
Rate for Payer: Humana Medicare	$14,547.70
Rate for Payer: Kaiser Permanente Medicare	$14,547.70
Rate for Payer: Ohana Health Plan Medicare	$14,547.70
Rate for Payer: UnitedHealthcare Medicare	$14,547.70

INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$13,652.35

Service Code	MSDRG 759
Min. Negotiated Rate	$6,975.84
Max. Negotiated Rate	$13,652.35
Rate for Payer: AlohaCare Medicare	$6,975.84
Rate for Payer: Hawaii Medical Service Association Commercial	$13,652.35
Rate for Payer: Hawaii Medical Service Association Medicare	$6,975.84
Rate for Payer: Humana Medicare	$6,975.84
Rate for Payer: Kaiser Permanente Medicare	$6,975.84
Rate for Payer: Ohana Health Plan Medicare	$6,975.84
Rate for Payer: UnitedHealthcare Medicare	$6,975.84

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC

Facility

$154,039.30

Service Code	MSDRG 854
Min. Negotiated Rate	$20,127.82
Max. Negotiated Rate	$154,039.30
Rate for Payer: AlohaCare Medicare	$20,127.82
Rate for Payer: Hawaii Medical Service Association Commercial	$154,039.30
Rate for Payer: Hawaii Medical Service Association Medicare	$20,127.82
Rate for Payer: Humana Medicare	$20,127.82
Rate for Payer: Kaiser Permanente Medicare	$20,127.82
Rate for Payer: Ohana Health Plan Medicare	$20,127.82
Rate for Payer: UnitedHealthcare Medicare	$20,127.82

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC

Facility

$154,039.30

Service Code	MSDRG 853
Min. Negotiated Rate	$49,107.49
Max. Negotiated Rate	$154,039.30
Rate for Payer: AlohaCare Medicare	$49,107.49
Rate for Payer: Hawaii Medical Service Association Commercial	$154,039.30
Rate for Payer: Hawaii Medical Service Association Medicare	$49,107.49
Rate for Payer: Humana Medicare	$49,107.49
Rate for Payer: Kaiser Permanente Medicare	$49,107.49
Rate for Payer: Ohana Health Plan Medicare	$49,107.49
Rate for Payer: UnitedHealthcare Medicare	$49,107.49

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$154,039.30

Service Code	MSDRG 855
Min. Negotiated Rate	$15,191.27
Max. Negotiated Rate	$154,039.30
Rate for Payer: AlohaCare Medicare	$15,191.27
Rate for Payer: Hawaii Medical Service Association Commercial	$154,039.30
Rate for Payer: Hawaii Medical Service Association Medicare	$15,191.27
Rate for Payer: Humana Medicare	$15,191.27
Rate for Payer: Kaiser Permanente Medicare	$15,191.27
Rate for Payer: Ohana Health Plan Medicare	$15,191.27
Rate for Payer: UnitedHealthcare Medicare	$15,191.27

INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$15,050.34

Service Code	MSDRG 727
Min. Negotiated Rate	$13,178.31
Max. Negotiated Rate	$15,050.34
Rate for Payer: AlohaCare Medicare	$15,050.34
Rate for Payer: Hawaii Medical Service Association Commercial	$13,178.31
Rate for Payer: Hawaii Medical Service Association Medicare	$15,050.34
Rate for Payer: Humana Medicare	$15,050.34
Rate for Payer: Kaiser Permanente Medicare	$15,050.34
Rate for Payer: Ohana Health Plan Medicare	$15,050.34
Rate for Payer: UnitedHealthcare Medicare	$15,050.34

INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC

Facility

$13,178.31

Service Code	MSDRG 728
Min. Negotiated Rate	$8,430.49
Max. Negotiated Rate	$13,178.31
Rate for Payer: AlohaCare Medicare	$8,430.49
Rate for Payer: Hawaii Medical Service Association Commercial	$13,178.31
Rate for Payer: Hawaii Medical Service Association Medicare	$8,430.49
Rate for Payer: Humana Medicare	$8,430.49
Rate for Payer: Kaiser Permanente Medicare	$8,430.49
Rate for Payer: Ohana Health Plan Medicare	$8,430.49
Rate for Payer: UnitedHealthcare Medicare	$8,430.49

INFLAMMATORY BOWEL DISEASE WITH CC

Facility

$19,435.64

Service Code	MSDRG 386
Min. Negotiated Rate	$10,057.61
Max. Negotiated Rate	$19,435.64
Rate for Payer: AlohaCare Medicare	$10,057.61
Rate for Payer: Hawaii Medical Service Association Commercial	$19,435.64
Rate for Payer: Hawaii Medical Service Association Medicare	$10,057.61
Rate for Payer: Humana Medicare	$10,057.61
Rate for Payer: Kaiser Permanente Medicare	$10,057.61
Rate for Payer: Ohana Health Plan Medicare	$10,057.61
Rate for Payer: UnitedHealthcare Medicare	$10,057.61

INFLAMMATORY BOWEL DISEASE WITH MCC

Facility

$19,435.64

Service Code	MSDRG 385
Min. Negotiated Rate	$16,029.95
Max. Negotiated Rate	$19,435.64
Rate for Payer: AlohaCare Medicare	$16,029.95
Rate for Payer: Hawaii Medical Service Association Commercial	$19,435.64
Rate for Payer: Hawaii Medical Service Association Medicare	$16,029.95
Rate for Payer: Humana Medicare	$16,029.95
Rate for Payer: Kaiser Permanente Medicare	$16,029.95
Rate for Payer: Ohana Health Plan Medicare	$16,029.95
Rate for Payer: UnitedHealthcare Medicare	$16,029.95

INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC

Facility

$19,435.64

Service Code	MSDRG 387
Min. Negotiated Rate	$7,150.27
Max. Negotiated Rate	$19,435.64
Rate for Payer: AlohaCare Medicare	$7,150.27
Rate for Payer: Hawaii Medical Service Association Commercial	$19,435.64
Rate for Payer: Hawaii Medical Service Association Medicare	$7,150.27
Rate for Payer: Humana Medicare	$7,150.27
Rate for Payer: Kaiser Permanente Medicare	$7,150.27
Rate for Payer: Ohana Health Plan Medicare	$7,150.27
Rate for Payer: UnitedHealthcare Medicare	$7,150.27

Influenza AB

Facility

$232.00

Service Code	HCPCS 86710
Hospital Charge Code	86710
Hospital Revenue Code	302
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$225.04
Rate for Payer: AlohaCare Medicaid	$116.00
Rate for Payer: Cash Price	$150.80
Rate for Payer: Cash Price	$150.80
Rate for Payer: Hawaii Medical Service Association ABD	$11.36
Rate for Payer: Hawaii Medical Service Association Commercial	$16.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.73
Rate for Payer: Hawaii Western Management Group Commercial	$13.55
Rate for Payer: Health Management Network Commercial	$197.20
Rate for Payer: Kaiser Permanente Commercial	$208.80
Rate for Payer: Kaiser Permanente Medicaid	$118.32
Rate for Payer: MDX Hawaii PPO	$225.04
Rate for Payer: UnitedHealthcare Medicaid	$11.36
Rate for Payer: University Health Alliance Commercial	$35.04

Influenza AB

Facility

$232.00

Service Code	HCPCS 86710
Hospital Charge Code	86710
Hospital Revenue Code	302
Min. Negotiated Rate	$197.20
Max. Negotiated Rate	$225.04
Rate for Payer: Cash Price	$150.80
Rate for Payer: Health Management Network Commercial	$197.20
Rate for Payer: Kaiser Permanente Commercial	$208.80
Rate for Payer: MDX Hawaii PPO	$225.04

Influenza A&B amp prob

Facility

$1,442.00

Service Code	HCPCS 87502
Hospital Charge Code	87502
Hospital Revenue Code	306
Min. Negotiated Rate	$1,225.70
Max. Negotiated Rate	$1,398.74
Rate for Payer: Cash Price	$937.30
Rate for Payer: Health Management Network Commercial	$1,225.70
Rate for Payer: Kaiser Permanente Commercial	$1,297.80
Rate for Payer: MDX Hawaii PPO	$1,398.74

Influenza A&B amp prob

Facility

$1,442.00

Service Code	HCPCS 87502
Hospital Charge Code	87502
Hospital Revenue Code	306
Min. Negotiated Rate	$95.80
Max. Negotiated Rate	$1,398.74
Rate for Payer: AlohaCare Medicaid	$721.00
Rate for Payer: Cash Price	$937.30
Rate for Payer: Cash Price	$937.30
Rate for Payer: Hawaii Medical Service Association ABD	$119.75
Rate for Payer: Hawaii Medical Service Association Commercial	$119.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$117.54
Rate for Payer: Hawaii Western Management Group Commercial	$95.80
Rate for Payer: Health Management Network Commercial	$1,225.70
Rate for Payer: Kaiser Permanente Commercial	$1,297.80
Rate for Payer: Kaiser Permanente Medicaid	$735.42
Rate for Payer: MDX Hawaii PPO	$1,398.74
Rate for Payer: UnitedHealthcare Medicaid	$119.75
Rate for Payer: University Health Alliance Commercial	$221.54

Know your out-of-pocket cost for care.

All Charges