Leahi Hospital

All Charges

Charge

Type

Setting

Price

Influenza AG

Facility

$205.00

Service Code	HCPCS 87804
Hospital Charge Code	87804
Hospital Revenue Code	306
Min. Negotiated Rate	$174.25
Max. Negotiated Rate	$198.85
Rate for Payer: Cash Price	$133.25
Rate for Payer: Health Management Network Commercial	$174.25
Rate for Payer: Kaiser Permanente Commercial	$184.50
Rate for Payer: MDX Hawaii PPO	$198.85

Influenza AG

Facility

$205.00

Service Code	HCPCS 87804
Hospital Charge Code	87804
Hospital Revenue Code	306
Min. Negotiated Rate	$16.55
Max. Negotiated Rate	$198.85
Rate for Payer: AlohaCare Medicaid	$102.50
Rate for Payer: Cash Price	$133.25
Rate for Payer: Cash Price	$133.25
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$20.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.55
Rate for Payer: Health Management Network Commercial	$174.25
Rate for Payer: Kaiser Permanente Commercial	$184.50
Rate for Payer: Kaiser Permanente Medicaid	$104.55
Rate for Payer: MDX Hawaii PPO	$198.85
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: University Health Alliance Commercial	$31.01

Influenza vaccine Afluria

Facility

$36.00

Service Code	HCPCS 90656
Hospital Charge Code	AFLU
Hospital Revenue Code	636
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: MDX Hawaii PPO	$34.92

Influenza vaccine Afluria

Facility

$36.00

Service Code	HCPCS 90656
Hospital Charge Code	AFLU
Hospital Revenue Code	636
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$34.92
Rate for Payer: AlohaCare Medicaid	$18.00
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cash Price	$23.40
Rate for Payer: Hawaii Medical Service Association ABD	$22.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.35
Rate for Payer: Hawaii Western Management Group Commercial	$34.20
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: UnitedHealthcare Medicaid	$21.60
Rate for Payer: University Health Alliance Commercial	$26.24

Influenza vaccine Fluzone High Dose

Facility

$173.00

Service Code	HCPCS 90662
Hospital Charge Code	FLU-HD
Hospital Revenue Code	636
Min. Negotiated Rate	$83.49
Max. Negotiated Rate	$167.81
Rate for Payer: AlohaCare Medicaid	$86.50
Rate for Payer: Cash Price	$112.45
Rate for Payer: Cash Price	$112.45
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	$164.35
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: Kaiser Permanente Medicaid	$88.23
Rate for Payer: MDX Hawaii PPO	$167.81
Rate for Payer: UnitedHealthcare Medicaid	$103.80
Rate for Payer: University Health Alliance Commercial	$126.10

Influenza vaccine Fluzone High Dose

Facility

$173.00

Service Code	HCPCS 90662
Hospital Charge Code	FLU-HD
Hospital Revenue Code	636
Min. Negotiated Rate	$147.05
Max. Negotiated Rate	$167.81
Rate for Payer: Cash Price	$112.45
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: MDX Hawaii PPO	$167.81

INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC

Facility

$29,888.22

Service Code	MSDRG 351
Min. Negotiated Rate	$15,460.32
Max. Negotiated Rate	$29,888.22
Rate for Payer: AlohaCare Medicare	$15,460.32
Rate for Payer: Hawaii Medical Service Association Commercial	$29,888.22
Rate for Payer: Hawaii Medical Service Association Medicare	$15,460.32
Rate for Payer: Humana Medicare	$15,460.32
Rate for Payer: Kaiser Permanente Medicare	$15,460.32
Rate for Payer: Ohana Health Plan Medicare	$15,460.32
Rate for Payer: UnitedHealthcare Medicare	$15,460.32

INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC

Facility

$37,117.33

Service Code	MSDRG 350
Min. Negotiated Rate	$24,994.40
Max. Negotiated Rate	$37,117.33
Rate for Payer: AlohaCare Medicare	$24,994.40
Rate for Payer: Hawaii Medical Service Association Commercial	$37,117.33
Rate for Payer: Hawaii Medical Service Association Medicare	$24,994.40
Rate for Payer: Humana Medicare	$24,994.40
Rate for Payer: Kaiser Permanente Medicare	$24,994.40
Rate for Payer: Ohana Health Plan Medicare	$24,994.40
Rate for Payer: UnitedHealthcare Medicare	$24,994.40

INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC

Facility

$15,453.70

Service Code	MSDRG 352
Min. Negotiated Rate	$11,944.91
Max. Negotiated Rate	$15,453.70
Rate for Payer: AlohaCare Medicare	$11,944.91
Rate for Payer: Hawaii Medical Service Association Commercial	$15,453.70
Rate for Payer: Hawaii Medical Service Association Medicare	$11,944.91
Rate for Payer: Humana Medicare	$11,944.91
Rate for Payer: Kaiser Permanente Medicare	$11,944.91
Rate for Payer: Ohana Health Plan Medicare	$11,944.91
Rate for Payer: UnitedHealthcare Medicare	$11,944.91

INTERSTITIAL LUNG DISEASE WITH CC

Facility

$34,391.60

Service Code	MSDRG 197
Min. Negotiated Rate	$9,789.55
Max. Negotiated Rate	$34,391.60
Rate for Payer: AlohaCare Medicare	$9,789.55
Rate for Payer: Hawaii Medical Service Association Commercial	$34,391.60
Rate for Payer: Hawaii Medical Service Association Medicare	$9,789.55
Rate for Payer: Humana Medicare	$9,789.55
Rate for Payer: Kaiser Permanente Medicare	$9,789.55
Rate for Payer: Ohana Health Plan Medicare	$9,789.55
Rate for Payer: UnitedHealthcare Medicare	$9,789.55

INTERSTITIAL LUNG DISEASE WITH MCC

Facility

$34,391.60

Service Code	MSDRG 196
Min. Negotiated Rate	$19,034.87
Max. Negotiated Rate	$34,391.60
Rate for Payer: AlohaCare Medicare	$19,034.87
Rate for Payer: Hawaii Medical Service Association Commercial	$34,391.60
Rate for Payer: Hawaii Medical Service Association Medicare	$19,034.87
Rate for Payer: Humana Medicare	$19,034.87
Rate for Payer: Kaiser Permanente Medicare	$19,034.87
Rate for Payer: Ohana Health Plan Medicare	$19,034.87
Rate for Payer: UnitedHealthcare Medicare	$19,034.87

INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC

Facility

$34,391.60

Service Code	MSDRG 198
Min. Negotiated Rate	$7,494.23
Max. Negotiated Rate	$34,391.60
Rate for Payer: AlohaCare Medicare	$7,494.23
Rate for Payer: Hawaii Medical Service Association Commercial	$34,391.60
Rate for Payer: Hawaii Medical Service Association Medicare	$7,494.23
Rate for Payer: Humana Medicare	$7,494.23
Rate for Payer: Kaiser Permanente Medicare	$7,494.23
Rate for Payer: Ohana Health Plan Medicare	$7,494.23
Rate for Payer: UnitedHealthcare Medicare	$7,494.23

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS

Facility

$34,415.30

Service Code	MSDRG 065
Min. Negotiated Rate	$10,392.70
Max. Negotiated Rate	$34,415.30
Rate for Payer: AlohaCare Medicare	$10,392.70
Rate for Payer: Hawaii Medical Service Association Commercial	$34,415.30
Rate for Payer: Hawaii Medical Service Association Medicare	$10,392.70
Rate for Payer: Humana Medicare	$10,392.70
Rate for Payer: Kaiser Permanente Medicare	$10,392.70
Rate for Payer: Ohana Health Plan Medicare	$10,392.70
Rate for Payer: UnitedHealthcare Medicare	$10,392.70

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC

Facility

$34,415.30

Service Code	MSDRG 064
Min. Negotiated Rate	$20,254.95
Max. Negotiated Rate	$34,415.30
Rate for Payer: AlohaCare Medicare	$20,254.95
Rate for Payer: Hawaii Medical Service Association Commercial	$34,415.30
Rate for Payer: Hawaii Medical Service Association Medicare	$20,254.95
Rate for Payer: Humana Medicare	$20,254.95
Rate for Payer: Kaiser Permanente Medicare	$20,254.95
Rate for Payer: Ohana Health Plan Medicare	$20,254.95
Rate for Payer: UnitedHealthcare Medicare	$20,254.95

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC

Facility

$34,415.30

Service Code	MSDRG 066
Min. Negotiated Rate	$7,180.84
Max. Negotiated Rate	$34,415.30
Rate for Payer: AlohaCare Medicare	$7,180.84
Rate for Payer: Hawaii Medical Service Association Commercial	$34,415.30
Rate for Payer: Hawaii Medical Service Association Medicare	$7,180.84
Rate for Payer: Humana Medicare	$7,180.84
Rate for Payer: Kaiser Permanente Medicare	$7,180.84
Rate for Payer: Ohana Health Plan Medicare	$7,180.84
Rate for Payer: UnitedHealthcare Medicare	$7,180.84

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC

Facility

$245,292.00

Service Code	MSDRG 021
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$245,292.00
Rate for Payer: AlohaCare Medicare	$52,608.13
Rate for Payer: Hawaii Medical Service Association Commercial	$245,292.00
Rate for Payer: Hawaii Medical Service Association Medicare	$52,608.13
Rate for Payer: Humana Medicare	$52,608.13
Rate for Payer: Kaiser Permanente Medicare	$52,608.13
Rate for Payer: Ohana Health Plan Medicare	$52,608.13
Rate for Payer: UnitedHealthcare Medicare	$52,608.13
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC

Facility

$245,292.00

Service Code	MSDRG 020
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$245,292.00
Rate for Payer: AlohaCare Medicare	$77,985.69
Rate for Payer: Hawaii Medical Service Association Commercial	$245,292.00
Rate for Payer: Hawaii Medical Service Association Medicare	$77,985.69
Rate for Payer: Humana Medicare	$77,985.69
Rate for Payer: Kaiser Permanente Medicare	$77,985.69
Rate for Payer: Ohana Health Plan Medicare	$77,985.69
Rate for Payer: UnitedHealthcare Medicare	$77,985.69
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC

Facility

$245,292.00

Service Code	MSDRG 022
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$245,292.00
Rate for Payer: AlohaCare Medicare	$31,750.24
Rate for Payer: Hawaii Medical Service Association Commercial	$245,292.00
Rate for Payer: Hawaii Medical Service Association Medicare	$31,750.24
Rate for Payer: Humana Medicare	$31,750.24
Rate for Payer: Kaiser Permanente Medicare	$31,750.24
Rate for Payer: Ohana Health Plan Medicare	$31,750.24
Rate for Payer: UnitedHealthcare Medicare	$31,750.24
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRAOCULAR PROCEDURES WITH CC/MCC

Facility

$18,511.26

Service Code	MSDRG 116
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$18,511.26
Rate for Payer: AlohaCare Medicare	$18,255.30
Rate for Payer: Hawaii Medical Service Association Commercial	$18,511.26
Rate for Payer: Hawaii Medical Service Association Medicare	$18,255.30
Rate for Payer: Humana Medicare	$18,255.30
Rate for Payer: Kaiser Permanente Medicare	$18,255.30
Rate for Payer: Ohana Health Plan Medicare	$18,255.30
Rate for Payer: UnitedHealthcare Medicare	$18,255.30
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRAOCULAR PROCEDURES WITHOUT CC/MCC

Facility

$18,345.35

Service Code	MSDRG 117
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$18,345.35
Rate for Payer: AlohaCare Medicare	$11,127.91
Rate for Payer: Hawaii Medical Service Association Commercial	$18,345.35
Rate for Payer: Hawaii Medical Service Association Medicare	$11,127.91
Rate for Payer: Humana Medicare	$11,127.91
Rate for Payer: Kaiser Permanente Medicare	$11,127.91
Rate for Payer: Ohana Health Plan Medicare	$11,127.91
Rate for Payer: UnitedHealthcare Medicare	$11,127.91
Rate for Payer: University Health Alliance Commercial	$10,400.00

Iontophoresis 15 min ca

Facility

$152.00

Service Code	HCPCS 97033 GP
Hospital Charge Code	PT97033
Hospital Revenue Code	420
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$98.80
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: MDX Hawaii PPO	$147.44

Iontophoresis 15 min ca

Facility

$152.00

Service Code	HCPCS 97033 GP
Hospital Charge Code	PT97033
Hospital Revenue Code	420
Min. Negotiated Rate	$13.64
Max. Negotiated Rate	$147.44
Rate for Payer: AlohaCare Medicaid	$76.00
Rate for Payer: Cash Price	$98.80
Rate for Payer: Cash Price	$98.80
Rate for Payer: Hawaii Western Management Group Commercial	$144.40
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: Kaiser Permanente Medicaid	$77.52
Rate for Payer: MDX Hawaii PPO	$147.44
Rate for Payer: UnitedHealthcare Medicaid	$13.64
Rate for Payer: University Health Alliance Commercial	$110.79

Iron

Facility

$124.00

Service Code	HCPCS 83540
Hospital Charge Code	83540
Hospital Revenue Code	301
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$120.28
Rate for Payer: AlohaCare Medicaid	$62.00
Rate for Payer: Cash Price	$80.60
Rate for Payer: Cash Price	$80.60
Rate for Payer: Hawaii Medical Service Association ABD	$8.95
Rate for Payer: Hawaii Medical Service Association Commercial	$8.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.40
Rate for Payer: Hawaii Western Management Group Commercial	$6.47
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Kaiser Permanente Commercial	$111.60
Rate for Payer: Kaiser Permanente Medicaid	$63.24
Rate for Payer: MDX Hawaii PPO	$120.28
Rate for Payer: UnitedHealthcare Medicaid	$8.95
Rate for Payer: University Health Alliance Commercial	$16.74

Iron

Facility

$124.00

Service Code	HCPCS 83540
Hospital Charge Code	83540
Hospital Revenue Code	301
Min. Negotiated Rate	$105.40
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$80.60
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Kaiser Permanente Commercial	$111.60
Rate for Payer: MDX Hawaii PPO	$120.28

Iron binding capacity

Facility

$18.00

Service Code	HCPCS 83550
Hospital Charge Code	83550
Hospital Revenue Code	301
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$22.59
Rate for Payer: AlohaCare Medicaid	$9.00
Rate for Payer: Cash Price	$11.70
Rate for Payer: Cash Price	$11.70
Rate for Payer: Hawaii Medical Service Association ABD	$12.08
Rate for Payer: Hawaii Medical Service Association Commercial	$10.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.68
Rate for Payer: Hawaii Western Management Group Commercial	$8.74
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: UnitedHealthcare Medicaid	$12.08
Rate for Payer: University Health Alliance Commercial	$22.59

Know your out-of-pocket cost for care.

All Charges