Leahi Hospital

All Charges

Charge

Type

Setting

Price

AFTERCARE WITH CC/MCC

Facility

$17,610.59

Service Code	MSDRG 949
Min. Negotiated Rate	$12,160.75
Max. Negotiated Rate	$17,610.59
Rate for Payer: AlohaCare Medicare	$12,160.75
Rate for Payer: Hawaii Medical Service Association Commercial	$17,610.59
Rate for Payer: Hawaii Medical Service Association Medicare	$12,160.75
Rate for Payer: Humana Medicare	$12,160.75
Rate for Payer: Kaiser Permanente Medicare	$12,160.75
Rate for Payer: Ohana Health Plan Medicare	$12,160.75
Rate for Payer: UnitedHealthcare Medicare	$12,160.75

AFTERCARE WITHOUT CC/MCC

Facility

$6,622.03

Service Code	MSDRG 950
Min. Negotiated Rate	$5,214.44
Max. Negotiated Rate	$6,622.03
Rate for Payer: AlohaCare Medicare	$6,622.03
Rate for Payer: Hawaii Medical Service Association Commercial	$5,214.44
Rate for Payer: Hawaii Medical Service Association Medicare	$6,622.03
Rate for Payer: Humana Medicare	$6,622.03
Rate for Payer: Kaiser Permanente Medicare	$6,622.03
Rate for Payer: Ohana Health Plan Medicare	$6,622.03
Rate for Payer: UnitedHealthcare Medicare	$6,622.03

AG detect NOS

Facility

$257.00

Service Code	HCPCS 87449
Hospital Charge Code	87449
Hospital Revenue Code	306
Min. Negotiated Rate	$218.45
Max. Negotiated Rate	$249.29
Rate for Payer: Cash Price	$167.05
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: MDX Hawaii PPO	$249.29

AG detect NOS

Facility

$257.00

Service Code	HCPCS 87449
Hospital Charge Code	87449
Hospital Revenue Code	306
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$249.29
Rate for Payer: AlohaCare Medicaid	$128.50
Rate for Payer: Cash Price	$167.05
Rate for Payer: Cash Price	$167.05
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: Kaiser Permanente Medicaid	$131.07
Rate for Payer: MDX Hawaii PPO	$249.29
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: University Health Alliance Commercial	$31.01

AICD GENERATOR PROCEDURES

Facility

$77,315.92

Service Code	MSDRG 245
Min. Negotiated Rate	$45,399.91
Max. Negotiated Rate	$77,315.92
Rate for Payer: AlohaCare Medicare	$45,399.91
Rate for Payer: Hawaii Medical Service Association Commercial	$77,315.92
Rate for Payer: Hawaii Medical Service Association Medicare	$45,399.91
Rate for Payer: Humana Medicare	$45,399.91
Rate for Payer: Kaiser Permanente Medicare	$45,399.91
Rate for Payer: Ohana Health Plan Medicare	$45,399.91
Rate for Payer: UnitedHealthcare Medicare	$45,399.91

AICD LEAD PROCEDURES

Facility

$77,315.92

Service Code	MSDRG 265
Min. Negotiated Rate	$36,094.49
Max. Negotiated Rate	$77,315.92
Rate for Payer: AlohaCare Medicare	$36,094.49
Rate for Payer: Hawaii Medical Service Association Commercial	$77,315.92
Rate for Payer: Hawaii Medical Service Association Medicare	$36,094.49
Rate for Payer: Humana Medicare	$36,094.49
Rate for Payer: Kaiser Permanente Medicare	$36,094.49
Rate for Payer: Ohana Health Plan Medicare	$36,094.49
Rate for Payer: UnitedHealthcare Medicare	$36,094.49

Albumin serum

Facility

$84.00

Service Code	HCPCS 82040
Hospital Charge Code	82040
Hospital Revenue Code	301
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$54.60
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: MDX Hawaii PPO	$81.48

Albumin serum

Facility

$84.00

Service Code	HCPCS 82040
Hospital Charge Code	82040
Hospital Revenue Code	301
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$81.48
Rate for Payer: AlohaCare Medicaid	$42.00
Rate for Payer: Cash Price	$54.60
Rate for Payer: Cash Price	$54.60
Rate for Payer: Hawaii Medical Service Association ABD	$6.85
Rate for Payer: Hawaii Medical Service Association Commercial	$6.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.19
Rate for Payer: Hawaii Western Management Group Commercial	$4.95
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: UnitedHealthcare Medicaid	$6.85
Rate for Payer: University Health Alliance Commercial	$12.80

ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA

Facility

$8,461.61

Service Code	MSDRG 894
Min. Negotiated Rate	$6,515.59
Max. Negotiated Rate	$8,461.61
Rate for Payer: AlohaCare Medicare	$6,515.59
Rate for Payer: Hawaii Medical Service Association Commercial	$8,461.61
Rate for Payer: Hawaii Medical Service Association Medicare	$6,515.59
Rate for Payer: Humana Medicare	$6,515.59
Rate for Payer: Kaiser Permanente Medicare	$6,515.59
Rate for Payer: Ohana Health Plan Medicare	$6,515.59
Rate for Payer: UnitedHealthcare Medicare	$6,515.59

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC

Facility

$22,588.01

Service Code	MSDRG 896
Min. Negotiated Rate	$17,634.42
Max. Negotiated Rate	$22,588.01
Rate for Payer: AlohaCare Medicare	$17,634.42
Rate for Payer: Hawaii Medical Service Association Commercial	$22,588.01
Rate for Payer: Hawaii Medical Service Association Medicare	$17,634.42
Rate for Payer: Humana Medicare	$17,634.42
Rate for Payer: Kaiser Permanente Medicare	$17,634.42
Rate for Payer: Ohana Health Plan Medicare	$17,634.42
Rate for Payer: UnitedHealthcare Medicare	$17,634.42

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC

Facility

$14,410.82

Service Code	MSDRG 897
Min. Negotiated Rate	$9,136.14
Max. Negotiated Rate	$14,410.82
Rate for Payer: AlohaCare Medicare	$9,136.14
Rate for Payer: Hawaii Medical Service Association Commercial	$14,410.82
Rate for Payer: Hawaii Medical Service Association Medicare	$9,136.14
Rate for Payer: Humana Medicare	$9,136.14
Rate for Payer: Kaiser Permanente Medicare	$9,136.14
Rate for Payer: Ohana Health Plan Medicare	$9,136.14
Rate for Payer: UnitedHealthcare Medicare	$9,136.14

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY

Facility

$22,588.01

Service Code	MSDRG 895
Min. Negotiated Rate	$14,387.08
Max. Negotiated Rate	$22,588.01
Rate for Payer: AlohaCare Medicare	$14,387.08
Rate for Payer: Hawaii Medical Service Association Commercial	$22,588.01
Rate for Payer: Hawaii Medical Service Association Medicare	$14,387.08
Rate for Payer: Humana Medicare	$14,387.08
Rate for Payer: Kaiser Permanente Medicare	$14,387.08
Rate for Payer: Ohana Health Plan Medicare	$14,387.08
Rate for Payer: UnitedHealthcare Medicare	$14,387.08

ALLERGIC REACTIONS WITH MCC

Facility

$17,008.59

Service Code	MSDRG 915
Min. Negotiated Rate	$13,130.91
Max. Negotiated Rate	$17,008.59
Rate for Payer: AlohaCare Medicare	$17,008.59
Rate for Payer: Hawaii Medical Service Association Commercial	$13,130.91
Rate for Payer: Hawaii Medical Service Association Medicare	$17,008.59
Rate for Payer: Humana Medicare	$17,008.59
Rate for Payer: Kaiser Permanente Medicare	$17,008.59
Rate for Payer: Ohana Health Plan Medicare	$17,008.59
Rate for Payer: UnitedHealthcare Medicare	$17,008.59

ALLERGIC REACTIONS WITHOUT MCC

Facility

$13,130.91

Service Code	MSDRG 916
Min. Negotiated Rate	$7,002.45
Max. Negotiated Rate	$13,130.91
Rate for Payer: AlohaCare Medicare	$7,002.45
Rate for Payer: Hawaii Medical Service Association Commercial	$13,130.91
Rate for Payer: Hawaii Medical Service Association Medicare	$7,002.45
Rate for Payer: Humana Medicare	$7,002.45
Rate for Payer: Kaiser Permanente Medicare	$7,002.45
Rate for Payer: Ohana Health Plan Medicare	$7,002.45
Rate for Payer: UnitedHealthcare Medicare	$7,002.45

ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$228,961.32

Service Code	MSDRG 014
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$228,961.32
Rate for Payer: AlohaCare Medicare	$118,876.53
Rate for Payer: Hawaii Medical Service Association Commercial	$228,961.32
Rate for Payer: Hawaii Medical Service Association Medicare	$118,876.53
Rate for Payer: Humana Medicare	$118,876.53
Rate for Payer: Kaiser Permanente Medicare	$118,876.53
Rate for Payer: Ohana Health Plan Medicare	$118,876.53
Rate for Payer: UnitedHealthcare Medicare	$118,876.53
Rate for Payer: University Health Alliance Commercial	$10,400.00

Amikacin trough

Facility

$258.00

Service Code	HCPCS 80150
Hospital Charge Code	80150
Hospital Revenue Code	301
Min. Negotiated Rate	$219.30
Max. Negotiated Rate	$250.26
Rate for Payer: Cash Price	$167.70
Rate for Payer: Health Management Network Commercial	$219.30
Rate for Payer: Kaiser Permanente Commercial	$232.20
Rate for Payer: MDX Hawaii PPO	$250.26

Amikacin trough

Facility

$258.00

Service Code	HCPCS 80150
Hospital Charge Code	80150
Hospital Revenue Code	301
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$250.26
Rate for Payer: AlohaCare Medicaid	$129.00
Rate for Payer: Cash Price	$167.70
Rate for Payer: Cash Price	$167.70
Rate for Payer: Hawaii Medical Service Association ABD	$20.83
Rate for Payer: Hawaii Medical Service Association Commercial	$18.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.87
Rate for Payer: Hawaii Western Management Group Commercial	$15.08
Rate for Payer: Health Management Network Commercial	$219.30
Rate for Payer: Kaiser Permanente Commercial	$232.20
Rate for Payer: Kaiser Permanente Medicaid	$131.58
Rate for Payer: MDX Hawaii PPO	$250.26
Rate for Payer: UnitedHealthcare Medicaid	$20.83
Rate for Payer: University Health Alliance Commercial	$38.96

Ammonia

Facility

$277.00

Service Code	HCPCS 82140
Hospital Charge Code	82140
Hospital Revenue Code	301
Min. Negotiated Rate	$235.45
Max. Negotiated Rate	$268.69
Rate for Payer: Cash Price	$180.05
Rate for Payer: Health Management Network Commercial	$235.45
Rate for Payer: Kaiser Permanente Commercial	$249.30
Rate for Payer: MDX Hawaii PPO	$268.69

Ammonia

Facility

$277.00

Service Code	HCPCS 82140
Hospital Charge Code	82140
Hospital Revenue Code	301
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$268.69
Rate for Payer: AlohaCare Medicaid	$138.50
Rate for Payer: Cash Price	$180.05
Rate for Payer: Cash Price	$180.05
Rate for Payer: Hawaii Medical Service Association ABD	$20.14
Rate for Payer: Hawaii Medical Service Association Commercial	$18.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.15
Rate for Payer: Hawaii Western Management Group Commercial	$14.57
Rate for Payer: Health Management Network Commercial	$235.45
Rate for Payer: Kaiser Permanente Commercial	$249.30
Rate for Payer: Kaiser Permanente Medicaid	$141.27
Rate for Payer: MDX Hawaii PPO	$268.69
Rate for Payer: UnitedHealthcare Medicaid	$20.14
Rate for Payer: University Health Alliance Commercial	$37.67

AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC

Facility

$80,800.12

Service Code	MSDRG 240
Min. Negotiated Rate	$28,528.52
Max. Negotiated Rate	$80,800.12
Rate for Payer: AlohaCare Medicare	$28,528.52
Rate for Payer: Hawaii Medical Service Association Commercial	$80,800.12
Rate for Payer: Hawaii Medical Service Association Medicare	$28,528.52
Rate for Payer: Humana Medicare	$28,528.52
Rate for Payer: Kaiser Permanente Medicare	$28,528.52
Rate for Payer: Ohana Health Plan Medicare	$28,528.52
Rate for Payer: UnitedHealthcare Medicare	$28,528.52

AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC

Facility

$80,800.12

Service Code	MSDRG 239
Min. Negotiated Rate	$48,940.94
Max. Negotiated Rate	$80,800.12
Rate for Payer: AlohaCare Medicare	$48,940.94
Rate for Payer: Hawaii Medical Service Association Commercial	$80,800.12
Rate for Payer: Hawaii Medical Service Association Medicare	$48,940.94
Rate for Payer: Humana Medicare	$48,940.94
Rate for Payer: Kaiser Permanente Medicare	$48,940.94
Rate for Payer: Ohana Health Plan Medicare	$48,940.94
Rate for Payer: UnitedHealthcare Medicare	$48,940.94

AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC

Facility

$80,800.12

Service Code	MSDRG 241
Min. Negotiated Rate	$14,079.58
Max. Negotiated Rate	$80,800.12
Rate for Payer: AlohaCare Medicare	$14,079.58
Rate for Payer: Hawaii Medical Service Association Commercial	$80,800.12
Rate for Payer: Hawaii Medical Service Association Medicare	$14,079.58
Rate for Payer: Humana Medicare	$14,079.58
Rate for Payer: Kaiser Permanente Medicare	$14,079.58
Rate for Payer: Ohana Health Plan Medicare	$14,079.58
Rate for Payer: UnitedHealthcare Medicare	$14,079.58

AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$40,696.33

Service Code	MSDRG 475
Min. Negotiated Rate	$22,863.67
Max. Negotiated Rate	$40,696.33
Rate for Payer: AlohaCare Medicare	$22,863.67
Rate for Payer: Hawaii Medical Service Association Commercial	$40,696.33
Rate for Payer: Hawaii Medical Service Association Medicare	$22,863.67
Rate for Payer: Humana Medicare	$22,863.67
Rate for Payer: Kaiser Permanente Medicare	$22,863.67
Rate for Payer: Ohana Health Plan Medicare	$22,863.67
Rate for Payer: UnitedHealthcare Medicare	$22,863.67

AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$42,743.90

Service Code	MSDRG 474
Min. Negotiated Rate	$40,696.33
Max. Negotiated Rate	$42,743.90
Rate for Payer: AlohaCare Medicare	$42,743.90
Rate for Payer: Hawaii Medical Service Association Commercial	$40,696.33
Rate for Payer: Hawaii Medical Service Association Medicare	$42,743.90
Rate for Payer: Humana Medicare	$42,743.90
Rate for Payer: Kaiser Permanente Medicare	$42,743.90
Rate for Payer: Ohana Health Plan Medicare	$42,743.90
Rate for Payer: UnitedHealthcare Medicare	$42,743.90

AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$40,696.33

Service Code	MSDRG 476
Min. Negotiated Rate	$12,067.12
Max. Negotiated Rate	$40,696.33
Rate for Payer: AlohaCare Medicare	$12,067.12
Rate for Payer: Hawaii Medical Service Association Commercial	$40,696.33
Rate for Payer: Hawaii Medical Service Association Medicare	$12,067.12
Rate for Payer: Humana Medicare	$12,067.12
Rate for Payer: Kaiser Permanente Medicare	$12,067.12
Rate for Payer: Ohana Health Plan Medicare	$12,067.12
Rate for Payer: UnitedHealthcare Medicare	$12,067.12

Know your out-of-pocket cost for care.

All Charges