Leahi Hospital

All Charges

Charge

Type

Setting

Price

Manual Therapy Technique

Facility

$192.00

Service Code	HCPCS 97140 GO
Hospital Charge Code	OT97140
Hospital Revenue Code	430
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$186.24
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: MDX Hawaii PPO	$186.24

Manual Therapy Technique

Facility

$192.00

Service Code	HCPCS 97140 GP
Hospital Charge Code	PT97140
Hospital Revenue Code	420
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$186.24
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: MDX Hawaii PPO	$186.24

Manual Therapy Technique

Facility

$192.00

Service Code	HCPCS 97140 GP
Hospital Charge Code	PT97140
Hospital Revenue Code	420
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$186.24
Rate for Payer: AlohaCare Medicaid	$96.00
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cash Price	$124.80
Rate for Payer: Hawaii Western Management Group Commercial	$182.40
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: Kaiser Permanente Medicaid	$97.92
Rate for Payer: MDX Hawaii PPO	$186.24
Rate for Payer: UnitedHealthcare Medicaid	$20.55
Rate for Payer: University Health Alliance Commercial	$139.95

Massage

Facility

$166.00

Service Code	HCPCS 97124 GO
Hospital Charge Code	OT97124
Hospital Revenue Code	430
Min. Negotiated Rate	$15.39
Max. Negotiated Rate	$161.02
Rate for Payer: AlohaCare Medicaid	$83.00
Rate for Payer: Cash Price	$107.90
Rate for Payer: Cash Price	$107.90
Rate for Payer: Hawaii Western Management Group Commercial	$157.70
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Kaiser Permanente Commercial	$149.40
Rate for Payer: Kaiser Permanente Medicaid	$84.66
Rate for Payer: MDX Hawaii PPO	$161.02
Rate for Payer: UnitedHealthcare Medicaid	$15.39
Rate for Payer: University Health Alliance Commercial	$121.00

Massage

Facility

$166.00

Service Code	HCPCS 97124 GP
Hospital Charge Code	PT97124
Hospital Revenue Code	420
Min. Negotiated Rate	$15.39
Max. Negotiated Rate	$161.02
Rate for Payer: AlohaCare Medicaid	$83.00
Rate for Payer: Cash Price	$107.90
Rate for Payer: Cash Price	$107.90
Rate for Payer: Hawaii Western Management Group Commercial	$157.70
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Kaiser Permanente Commercial	$149.40
Rate for Payer: Kaiser Permanente Medicaid	$84.66
Rate for Payer: MDX Hawaii PPO	$161.02
Rate for Payer: UnitedHealthcare Medicaid	$15.39
Rate for Payer: University Health Alliance Commercial	$121.00

Massage

Facility

$166.00

Service Code	HCPCS 97124 GP
Hospital Charge Code	PT97124
Hospital Revenue Code	420
Min. Negotiated Rate	$141.10
Max. Negotiated Rate	$161.02
Rate for Payer: Cash Price	$107.90
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Kaiser Permanente Commercial	$149.40
Rate for Payer: MDX Hawaii PPO	$161.02

Massage

Facility

$166.00

Service Code	HCPCS 97124 GO
Hospital Charge Code	OT97124
Hospital Revenue Code	430
Min. Negotiated Rate	$141.10
Max. Negotiated Rate	$161.02
Rate for Payer: Cash Price	$107.90
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Kaiser Permanente Commercial	$149.40
Rate for Payer: MDX Hawaii PPO	$161.02

MASTECTOMY FOR MALIGNANCY WITH CC/MCC

Facility

$25,029.31

Service Code	MSDRG 582
Min. Negotiated Rate	$19,423.15
Max. Negotiated Rate	$25,029.31
Rate for Payer: AlohaCare Medicare	$19,423.15
Rate for Payer: Hawaii Medical Service Association Commercial	$25,029.31
Rate for Payer: Hawaii Medical Service Association Medicare	$19,423.15
Rate for Payer: Humana Medicare	$19,423.15
Rate for Payer: Kaiser Permanente Medicare	$19,423.15
Rate for Payer: Ohana Health Plan Medicare	$19,423.15
Rate for Payer: UnitedHealthcare Medicare	$19,423.15

MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC

Facility

$22,848.73

Service Code	MSDRG 583
Min. Negotiated Rate	$17,430.42
Max. Negotiated Rate	$22,848.73
Rate for Payer: AlohaCare Medicare	$17,430.42
Rate for Payer: Hawaii Medical Service Association Commercial	$22,848.73
Rate for Payer: Hawaii Medical Service Association Medicare	$17,430.42
Rate for Payer: Humana Medicare	$17,430.42
Rate for Payer: Kaiser Permanente Medicare	$17,430.42
Rate for Payer: Ohana Health Plan Medicare	$17,430.42
Rate for Payer: UnitedHealthcare Medicare	$17,430.42

MEDICAL BACK PROBLEMS WITH MCC

Facility

$16,954.40

Service Code	MSDRG 551
Min. Negotiated Rate	$14,647.84
Max. Negotiated Rate	$16,954.40
Rate for Payer: AlohaCare Medicare	$16,954.40
Rate for Payer: Hawaii Medical Service Association Commercial	$14,647.84
Rate for Payer: Hawaii Medical Service Association Medicare	$16,954.40
Rate for Payer: Humana Medicare	$16,954.40
Rate for Payer: Kaiser Permanente Medicare	$16,954.40
Rate for Payer: Ohana Health Plan Medicare	$16,954.40
Rate for Payer: UnitedHealthcare Medicare	$16,954.40

MEDICAL BACK PROBLEMS WITHOUT MCC

Facility

$14,647.84

Service Code	MSDRG 552
Min. Negotiated Rate	$9,909.78
Max. Negotiated Rate	$14,647.84
Rate for Payer: AlohaCare Medicare	$9,909.78
Rate for Payer: Hawaii Medical Service Association Commercial	$14,647.84
Rate for Payer: Hawaii Medical Service Association Medicare	$9,909.78
Rate for Payer: Humana Medicare	$9,909.78
Rate for Payer: Kaiser Permanente Medicare	$9,909.78
Rate for Payer: Ohana Health Plan Medicare	$9,909.78
Rate for Payer: UnitedHealthcare Medicare	$9,909.78

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC

Facility

$11,993.21

Service Code	MSDRG 760
Min. Negotiated Rate	$10,365.09
Max. Negotiated Rate	$11,993.21
Rate for Payer: AlohaCare Medicare	$10,365.09
Rate for Payer: Hawaii Medical Service Association Commercial	$11,993.21
Rate for Payer: Hawaii Medical Service Association Medicare	$10,365.09
Rate for Payer: Humana Medicare	$10,365.09
Rate for Payer: Kaiser Permanente Medicare	$10,365.09
Rate for Payer: Ohana Health Plan Medicare	$10,365.09
Rate for Payer: UnitedHealthcare Medicare	$10,365.09

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$11,993.21

Service Code	MSDRG 761
Min. Negotiated Rate	$6,058.30
Max. Negotiated Rate	$11,993.21
Rate for Payer: AlohaCare Medicare	$6,058.30
Rate for Payer: Hawaii Medical Service Association Commercial	$11,993.21
Rate for Payer: Hawaii Medical Service Association Medicare	$6,058.30
Rate for Payer: Humana Medicare	$6,058.30
Rate for Payer: Kaiser Permanente Medicare	$6,058.30
Rate for Payer: Ohana Health Plan Medicare	$6,058.30
Rate for Payer: UnitedHealthcare Medicare	$6,058.30

Microalbumin Ur

Facility

$100.00

Service Code	HCPCS 82043
Hospital Charge Code	82043
Hospital Revenue Code	301
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Kaiser Permanente Commercial	$90.00
Rate for Payer: MDX Hawaii PPO	$97.00

Microalbumin Ur

Facility

$100.00

Service Code	HCPCS 82043
Hospital Charge Code	82043
Hospital Revenue Code	301
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$97.00
Rate for Payer: AlohaCare Medicaid	$50.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Hawaii Medical Service Association ABD	$8.00
Rate for Payer: Hawaii Medical Service Association Commercial	$7.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.40
Rate for Payer: Hawaii Western Management Group Commercial	$5.78
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Kaiser Permanente Commercial	$90.00
Rate for Payer: Kaiser Permanente Medicaid	$51.00
Rate for Payer: MDX Hawaii PPO	$97.00
Rate for Payer: UnitedHealthcare Medicaid	$8.00
Rate for Payer: University Health Alliance Commercial	$14.97

MINOR BLADDER PROCEDURES WITH CC

Facility

$24,365.66

Service Code	MSDRG 663
Min. Negotiated Rate	$15,417.95
Max. Negotiated Rate	$24,365.66
Rate for Payer: AlohaCare Medicare	$15,417.95
Rate for Payer: Hawaii Medical Service Association Commercial	$24,365.66
Rate for Payer: Hawaii Medical Service Association Medicare	$15,417.95
Rate for Payer: Humana Medicare	$15,417.95
Rate for Payer: Kaiser Permanente Medicare	$15,417.95
Rate for Payer: Ohana Health Plan Medicare	$15,417.95
Rate for Payer: UnitedHealthcare Medicare	$15,417.95

MINOR BLADDER PROCEDURES WITH MCC

Facility

$32,827.27

Service Code	MSDRG 662
Min. Negotiated Rate	$30,608.01
Max. Negotiated Rate	$32,827.27
Rate for Payer: AlohaCare Medicare	$30,608.01
Rate for Payer: Hawaii Medical Service Association Commercial	$32,827.27
Rate for Payer: Hawaii Medical Service Association Medicare	$30,608.01
Rate for Payer: Humana Medicare	$30,608.01
Rate for Payer: Kaiser Permanente Medicare	$30,608.01
Rate for Payer: Ohana Health Plan Medicare	$30,608.01
Rate for Payer: UnitedHealthcare Medicare	$30,608.01

MINOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$19,151.22

Service Code	MSDRG 664
Min. Negotiated Rate	$10,753.40
Max. Negotiated Rate	$19,151.22
Rate for Payer: AlohaCare Medicare	$10,753.40
Rate for Payer: Hawaii Medical Service Association Commercial	$19,151.22
Rate for Payer: Hawaii Medical Service Association Medicare	$10,753.40
Rate for Payer: Humana Medicare	$10,753.40
Rate for Payer: Kaiser Permanente Medicare	$10,753.40
Rate for Payer: Ohana Health Plan Medicare	$10,753.40
Rate for Payer: UnitedHealthcare Medicare	$10,753.40

MINOR SKIN DISORDERS WITH MCC

Facility

$15,348.95

Service Code	MSDRG 606
Min. Negotiated Rate	$13,913.07
Max. Negotiated Rate	$15,348.95
Rate for Payer: AlohaCare Medicare	$15,348.95
Rate for Payer: Hawaii Medical Service Association Commercial	$13,913.07
Rate for Payer: Hawaii Medical Service Association Medicare	$15,348.95
Rate for Payer: Humana Medicare	$15,348.95
Rate for Payer: Kaiser Permanente Medicare	$15,348.95
Rate for Payer: Ohana Health Plan Medicare	$15,348.95
Rate for Payer: UnitedHealthcare Medicare	$15,348.95

MINOR SKIN DISORDERS WITHOUT MCC

Facility

$12,538.36

Service Code	MSDRG 607
Min. Negotiated Rate	$9,368.72
Max. Negotiated Rate	$12,538.36
Rate for Payer: AlohaCare Medicare	$9,368.72
Rate for Payer: Hawaii Medical Service Association Commercial	$12,538.36
Rate for Payer: Hawaii Medical Service Association Medicare	$9,368.72
Rate for Payer: Humana Medicare	$9,368.72
Rate for Payer: Kaiser Permanente Medicare	$9,368.72
Rate for Payer: Ohana Health Plan Medicare	$9,368.72
Rate for Payer: UnitedHealthcare Medicare	$9,368.72

MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility

$32,448.04

Service Code	MSDRG 345
Min. Negotiated Rate	$15,265.19
Max. Negotiated Rate	$32,448.04
Rate for Payer: AlohaCare Medicare	$15,265.19
Rate for Payer: Hawaii Medical Service Association Commercial	$32,448.04
Rate for Payer: Hawaii Medical Service Association Medicare	$15,265.19
Rate for Payer: Humana Medicare	$15,265.19
Rate for Payer: Kaiser Permanente Medicare	$15,265.19
Rate for Payer: Ohana Health Plan Medicare	$15,265.19
Rate for Payer: UnitedHealthcare Medicare	$15,265.19

MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility

$36,287.76

Service Code	MSDRG 344
Min. Negotiated Rate	$25,890.25
Max. Negotiated Rate	$36,287.76
Rate for Payer: AlohaCare Medicare	$25,890.25
Rate for Payer: Hawaii Medical Service Association Commercial	$36,287.76
Rate for Payer: Hawaii Medical Service Association Medicare	$25,890.25
Rate for Payer: Humana Medicare	$25,890.25
Rate for Payer: Kaiser Permanente Medicare	$25,890.25
Rate for Payer: Ohana Health Plan Medicare	$25,890.25
Rate for Payer: UnitedHealthcare Medicare	$25,890.25

MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$26,688.45

Service Code	MSDRG 346
Min. Negotiated Rate	$12,126.25
Max. Negotiated Rate	$26,688.45
Rate for Payer: AlohaCare Medicare	$12,126.25
Rate for Payer: Hawaii Medical Service Association Commercial	$26,688.45
Rate for Payer: Hawaii Medical Service Association Medicare	$12,126.25
Rate for Payer: Humana Medicare	$12,126.25
Rate for Payer: Kaiser Permanente Medicare	$12,126.25
Rate for Payer: Ohana Health Plan Medicare	$12,126.25
Rate for Payer: UnitedHealthcare Medicare	$12,126.25

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC

Facility

$20,217.81

Service Code	MSDRG 640
Min. Negotiated Rate	$13,598.64
Max. Negotiated Rate	$20,217.81
Rate for Payer: AlohaCare Medicare	$13,598.64
Rate for Payer: Hawaii Medical Service Association Commercial	$20,217.81
Rate for Payer: Hawaii Medical Service Association Medicare	$13,598.64
Rate for Payer: Humana Medicare	$13,598.64
Rate for Payer: Kaiser Permanente Medicare	$13,598.64
Rate for Payer: Ohana Health Plan Medicare	$13,598.64
Rate for Payer: UnitedHealthcare Medicare	$13,598.64

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC

Facility

$15,738.13

Service Code	MSDRG 641
Min. Negotiated Rate	$8,105.27
Max. Negotiated Rate	$15,738.13
Rate for Payer: AlohaCare Medicare	$8,105.27
Rate for Payer: Hawaii Medical Service Association Commercial	$15,738.13
Rate for Payer: Hawaii Medical Service Association Medicare	$8,105.27
Rate for Payer: Humana Medicare	$8,105.27
Rate for Payer: Kaiser Permanente Medicare	$8,105.27
Rate for Payer: Ohana Health Plan Medicare	$8,105.27
Rate for Payer: UnitedHealthcare Medicare	$8,105.27

Know your out-of-pocket cost for care.

All Charges