Leahi Hospital

All Charges

Charge

Type

Setting

Price

LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC

Facility

$51,030.41

Service Code	MSDRG 842
Min. Negotiated Rate	$10,393.68
Max. Negotiated Rate	$51,030.41
Rate for Payer: AlohaCare Medicare	$10,393.68
Rate for Payer: Hawaii Medical Service Association Commercial	$51,030.41
Rate for Payer: Hawaii Medical Service Association Medicare	$10,393.68
Rate for Payer: Humana Medicare	$10,393.68
Rate for Payer: Kaiser Permanente Medicare	$10,393.68
Rate for Payer: Ohana Health Plan Medicare	$10,393.68
Rate for Payer: UnitedHealthcare Medicare	$10,393.68

Magnesium

Facility

$144.00

Service Code	HCPCS 83735
Hospital Charge Code	83735
Hospital Revenue Code	301
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$139.68
Rate for Payer: AlohaCare Medicaid	$72.00
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Hawaii Medical Service Association ABD	$9.26
Rate for Payer: Hawaii Medical Service Association Commercial	$8.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.72
Rate for Payer: Hawaii Western Management Group Commercial	$6.70
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Kaiser Permanente Commercial	$129.60
Rate for Payer: Kaiser Permanente Medicaid	$73.44
Rate for Payer: MDX Hawaii PPO	$139.68
Rate for Payer: UnitedHealthcare Medicaid	$9.26
Rate for Payer: University Health Alliance Commercial	$17.32

Magnesium

Facility

$144.00

Service Code	HCPCS 83735
Hospital Charge Code	83735
Hospital Revenue Code	301
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$139.68
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Kaiser Permanente Commercial	$129.60
Rate for Payer: MDX Hawaii PPO	$139.68

MAJOR BLADDER PROCEDURES WITH CC

Facility

$45,792.26

Service Code	MSDRG 654
Min. Negotiated Rate	$28,023.93
Max. Negotiated Rate	$45,792.26
Rate for Payer: AlohaCare Medicare	$28,023.93
Rate for Payer: Hawaii Medical Service Association Commercial	$45,792.26
Rate for Payer: Hawaii Medical Service Association Medicare	$28,023.93
Rate for Payer: Humana Medicare	$28,023.93
Rate for Payer: Kaiser Permanente Medicare	$28,023.93
Rate for Payer: Ohana Health Plan Medicare	$28,023.93
Rate for Payer: UnitedHealthcare Medicare	$28,023.93

MAJOR BLADDER PROCEDURES WITH MCC

Facility

$51,648.22

Service Code	MSDRG 653
Min. Negotiated Rate	$45,792.26
Max. Negotiated Rate	$51,648.22
Rate for Payer: AlohaCare Medicare	$51,648.22
Rate for Payer: Hawaii Medical Service Association Commercial	$45,792.26
Rate for Payer: Hawaii Medical Service Association Medicare	$51,648.22
Rate for Payer: Humana Medicare	$51,648.22
Rate for Payer: Kaiser Permanente Medicare	$51,648.22
Rate for Payer: Ohana Health Plan Medicare	$51,648.22
Rate for Payer: UnitedHealthcare Medicare	$51,648.22

MAJOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$45,792.26

Service Code	MSDRG 655
Min. Negotiated Rate	$21,295.68
Max. Negotiated Rate	$45,792.26
Rate for Payer: AlohaCare Medicare	$21,295.68
Rate for Payer: Hawaii Medical Service Association Commercial	$45,792.26
Rate for Payer: Hawaii Medical Service Association Medicare	$21,295.68
Rate for Payer: Humana Medicare	$21,295.68
Rate for Payer: Kaiser Permanente Medicare	$21,295.68
Rate for Payer: Ohana Health Plan Medicare	$21,295.68
Rate for Payer: UnitedHealthcare Medicare	$21,295.68

MAJOR CHEST PROCEDURES WITH CC

Facility

$63,213.23

Service Code	MSDRG 164
Min. Negotiated Rate	$25,310.76
Max. Negotiated Rate	$63,213.23
Rate for Payer: AlohaCare Medicare	$25,310.76
Rate for Payer: Hawaii Medical Service Association Commercial	$63,213.23
Rate for Payer: Hawaii Medical Service Association Medicare	$25,310.76
Rate for Payer: Humana Medicare	$25,310.76
Rate for Payer: Kaiser Permanente Medicare	$25,310.76
Rate for Payer: Ohana Health Plan Medicare	$25,310.76
Rate for Payer: UnitedHealthcare Medicare	$25,310.76

MAJOR CHEST PROCEDURES WITH MCC

Facility

$63,450.25

Service Code	MSDRG 163
Min. Negotiated Rate	$44,605.58
Max. Negotiated Rate	$63,450.25
Rate for Payer: AlohaCare Medicare	$44,605.58
Rate for Payer: Hawaii Medical Service Association Commercial	$63,450.25
Rate for Payer: Hawaii Medical Service Association Medicare	$44,605.58
Rate for Payer: Humana Medicare	$44,605.58
Rate for Payer: Kaiser Permanente Medicare	$44,605.58
Rate for Payer: Ohana Health Plan Medicare	$44,605.58
Rate for Payer: UnitedHealthcare Medicare	$44,605.58

MAJOR CHEST PROCEDURES WITHOUT CC/MCC

Facility

$45,436.73

Service Code	MSDRG 165
Min. Negotiated Rate	$19,300.95
Max. Negotiated Rate	$45,436.73
Rate for Payer: AlohaCare Medicare	$19,300.95
Rate for Payer: Hawaii Medical Service Association Commercial	$45,436.73
Rate for Payer: Hawaii Medical Service Association Medicare	$19,300.95
Rate for Payer: Humana Medicare	$19,300.95
Rate for Payer: Kaiser Permanente Medicare	$19,300.95
Rate for Payer: Ohana Health Plan Medicare	$19,300.95
Rate for Payer: UnitedHealthcare Medicare	$19,300.95

MAJOR CHEST TRAUMA WITH CC

Facility

$19,767.47

Service Code	MSDRG 184
Min. Negotiated Rate	$10,922.91
Max. Negotiated Rate	$19,767.47
Rate for Payer: AlohaCare Medicare	$10,922.91
Rate for Payer: Hawaii Medical Service Association Commercial	$19,767.47
Rate for Payer: Hawaii Medical Service Association Medicare	$10,922.91
Rate for Payer: Humana Medicare	$10,922.91
Rate for Payer: Kaiser Permanente Medicare	$10,922.91
Rate for Payer: Ohana Health Plan Medicare	$10,922.91
Rate for Payer: UnitedHealthcare Medicare	$10,922.91

MAJOR CHEST TRAUMA WITH MCC

Facility

$21,521.42

Service Code	MSDRG 183
Min. Negotiated Rate	$15,513.55
Max. Negotiated Rate	$21,521.42
Rate for Payer: AlohaCare Medicare	$15,513.55
Rate for Payer: Hawaii Medical Service Association Commercial	$21,521.42
Rate for Payer: Hawaii Medical Service Association Medicare	$15,513.55
Rate for Payer: Humana Medicare	$15,513.55
Rate for Payer: Kaiser Permanente Medicare	$15,513.55
Rate for Payer: Ohana Health Plan Medicare	$15,513.55
Rate for Payer: UnitedHealthcare Medicare	$15,513.55

MAJOR CHEST TRAUMA WITHOUT CC/MCC

Facility

$18,890.49

Service Code	MSDRG 185
Min. Negotiated Rate	$8,187.06
Max. Negotiated Rate	$18,890.49
Rate for Payer: AlohaCare Medicare	$8,187.06
Rate for Payer: Hawaii Medical Service Association Commercial	$18,890.49
Rate for Payer: Hawaii Medical Service Association Medicare	$8,187.06
Rate for Payer: Humana Medicare	$8,187.06
Rate for Payer: Kaiser Permanente Medicare	$8,187.06
Rate for Payer: Ohana Health Plan Medicare	$8,187.06
Rate for Payer: UnitedHealthcare Medicare	$8,187.06

MAJOR ESOPHAGEAL DISORDERS WITH CC

Facility

$19,340.83

Service Code	MSDRG 369
Min. Negotiated Rate	$10,293.15
Max. Negotiated Rate	$19,340.83
Rate for Payer: AlohaCare Medicare	$10,293.15
Rate for Payer: Hawaii Medical Service Association Commercial	$19,340.83
Rate for Payer: Hawaii Medical Service Association Medicare	$10,293.15
Rate for Payer: Humana Medicare	$10,293.15
Rate for Payer: Kaiser Permanente Medicare	$10,293.15
Rate for Payer: Ohana Health Plan Medicare	$10,293.15
Rate for Payer: UnitedHealthcare Medicare	$10,293.15

MAJOR ESOPHAGEAL DISORDERS WITH MCC

Facility

$19,340.83

Service Code	MSDRG 368
Min. Negotiated Rate	$16,124.57
Max. Negotiated Rate	$19,340.83
Rate for Payer: AlohaCare Medicare	$16,124.57
Rate for Payer: Hawaii Medical Service Association Commercial	$19,340.83
Rate for Payer: Hawaii Medical Service Association Medicare	$16,124.57
Rate for Payer: Humana Medicare	$16,124.57
Rate for Payer: Kaiser Permanente Medicare	$16,124.57
Rate for Payer: Ohana Health Plan Medicare	$16,124.57
Rate for Payer: UnitedHealthcare Medicare	$16,124.57

MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC

Facility

$19,340.83

Service Code	MSDRG 370
Min. Negotiated Rate	$7,342.46
Max. Negotiated Rate	$19,340.83
Rate for Payer: AlohaCare Medicare	$7,342.46
Rate for Payer: Hawaii Medical Service Association Commercial	$19,340.83
Rate for Payer: Hawaii Medical Service Association Medicare	$7,342.46
Rate for Payer: Humana Medicare	$7,342.46
Rate for Payer: Kaiser Permanente Medicare	$7,342.46
Rate for Payer: Ohana Health Plan Medicare	$7,342.46
Rate for Payer: UnitedHealthcare Medicare	$7,342.46

MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC

Facility

$21,995.46

Service Code	MSDRG 372
Min. Negotiated Rate	$10,498.16
Max. Negotiated Rate	$21,995.46
Rate for Payer: AlohaCare Medicare	$10,498.16
Rate for Payer: Hawaii Medical Service Association Commercial	$21,995.46
Rate for Payer: Hawaii Medical Service Association Medicare	$10,498.16
Rate for Payer: Humana Medicare	$10,498.16
Rate for Payer: Kaiser Permanente Medicare	$10,498.16
Rate for Payer: Ohana Health Plan Medicare	$10,498.16
Rate for Payer: UnitedHealthcare Medicare	$10,498.16

MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC

Facility

$21,995.46

Service Code	MSDRG 371
Min. Negotiated Rate	$17,910.37
Max. Negotiated Rate	$21,995.46
Rate for Payer: AlohaCare Medicare	$17,910.37
Rate for Payer: Hawaii Medical Service Association Commercial	$21,995.46
Rate for Payer: Hawaii Medical Service Association Medicare	$17,910.37
Rate for Payer: Humana Medicare	$17,910.37
Rate for Payer: Kaiser Permanente Medicare	$17,910.37
Rate for Payer: Ohana Health Plan Medicare	$17,910.37
Rate for Payer: UnitedHealthcare Medicare	$17,910.37

MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC

Facility

$21,995.46

Service Code	MSDRG 373
Min. Negotiated Rate	$7,604.61
Max. Negotiated Rate	$21,995.46
Rate for Payer: AlohaCare Medicare	$7,604.61
Rate for Payer: Hawaii Medical Service Association Commercial	$21,995.46
Rate for Payer: Hawaii Medical Service Association Medicare	$7,604.61
Rate for Payer: Humana Medicare	$7,604.61
Rate for Payer: Kaiser Permanente Medicare	$7,604.61
Rate for Payer: Ohana Health Plan Medicare	$7,604.61
Rate for Payer: UnitedHealthcare Medicare	$7,604.61

MAJOR HEAD AND NECK PROCEDURES WITH CC

Facility

$50,390.45

Service Code	MSDRG 141
Min. Negotiated Rate	$21,931.34
Max. Negotiated Rate	$50,390.45
Rate for Payer: AlohaCare Medicare	$21,931.34
Rate for Payer: Hawaii Medical Service Association Commercial	$50,390.45
Rate for Payer: Hawaii Medical Service Association Medicare	$21,931.34
Rate for Payer: Humana Medicare	$21,931.34
Rate for Payer: Kaiser Permanente Medicare	$21,931.34
Rate for Payer: Ohana Health Plan Medicare	$21,931.34
Rate for Payer: UnitedHealthcare Medicare	$21,931.34

MAJOR HEAD AND NECK PROCEDURES WITH MCC

Facility

$61,340.78

Service Code	MSDRG 140
Min. Negotiated Rate	$42,471.89
Max. Negotiated Rate	$61,340.78
Rate for Payer: AlohaCare Medicare	$42,471.89
Rate for Payer: Hawaii Medical Service Association Commercial	$61,340.78
Rate for Payer: Hawaii Medical Service Association Medicare	$42,471.89
Rate for Payer: Humana Medicare	$42,471.89
Rate for Payer: Kaiser Permanente Medicare	$42,471.89
Rate for Payer: Ohana Health Plan Medicare	$42,471.89
Rate for Payer: UnitedHealthcare Medicare	$42,471.89

MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC

Facility

$28,086.87

Service Code	MSDRG 142
Min. Negotiated Rate	$16,168.93
Max. Negotiated Rate	$28,086.87
Rate for Payer: AlohaCare Medicare	$16,168.93
Rate for Payer: Hawaii Medical Service Association Commercial	$28,086.87
Rate for Payer: Hawaii Medical Service Association Medicare	$16,168.93
Rate for Payer: Humana Medicare	$16,168.93
Rate for Payer: Kaiser Permanente Medicare	$16,168.93
Rate for Payer: Ohana Health Plan Medicare	$16,168.93
Rate for Payer: UnitedHealthcare Medicare	$16,168.93

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC

Facility

$34,913.05

Service Code	MSDRG 809
Min. Negotiated Rate	$12,911.73
Max. Negotiated Rate	$34,913.05
Rate for Payer: AlohaCare Medicare	$12,911.73
Rate for Payer: Hawaii Medical Service Association Commercial	$34,913.05
Rate for Payer: Hawaii Medical Service Association Medicare	$12,911.73
Rate for Payer: Humana Medicare	$12,911.73
Rate for Payer: Kaiser Permanente Medicare	$12,911.73
Rate for Payer: Ohana Health Plan Medicare	$12,911.73
Rate for Payer: UnitedHealthcare Medicare	$12,911.73

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC

Facility

$34,913.05

Service Code	MSDRG 808
Min. Negotiated Rate	$22,195.47
Max. Negotiated Rate	$34,913.05
Rate for Payer: AlohaCare Medicare	$22,195.47
Rate for Payer: Hawaii Medical Service Association Commercial	$34,913.05
Rate for Payer: Hawaii Medical Service Association Medicare	$22,195.47
Rate for Payer: Humana Medicare	$22,195.47
Rate for Payer: Kaiser Permanente Medicare	$22,195.47
Rate for Payer: Ohana Health Plan Medicare	$22,195.47
Rate for Payer: UnitedHealthcare Medicare	$22,195.47

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC

Facility

$34,913.05

Service Code	MSDRG 810
Min. Negotiated Rate	$10,750.44
Max. Negotiated Rate	$34,913.05
Rate for Payer: AlohaCare Medicare	$10,750.44
Rate for Payer: Hawaii Medical Service Association Commercial	$34,913.05
Rate for Payer: Hawaii Medical Service Association Medicare	$10,750.44
Rate for Payer: Humana Medicare	$10,750.44
Rate for Payer: Kaiser Permanente Medicare	$10,750.44
Rate for Payer: Ohana Health Plan Medicare	$10,750.44
Rate for Payer: UnitedHealthcare Medicare	$10,750.44

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT

Facility

$40,957.06

Service Code	MSDRG 469
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$40,957.06
Rate for Payer: AlohaCare Medicare	$30,329.10
Rate for Payer: Hawaii Medical Service Association Commercial	$40,957.06
Rate for Payer: Hawaii Medical Service Association Medicare	$30,329.10
Rate for Payer: Humana Medicare	$30,329.10
Rate for Payer: Kaiser Permanente Medicare	$30,329.10
Rate for Payer: Ohana Health Plan Medicare	$30,329.10
Rate for Payer: UnitedHealthcare Medicare	$30,329.10
Rate for Payer: University Health Alliance Commercial	$10,400.00

Know your out-of-pocket cost for care.

All Charges