Leahi Hospital

All Charges

Charge

Type

Setting

Price

Neg Pressure Wound TX > 50cm

Facility

$947.00

Service Code	HCPCS 97608 GP
Hospital Charge Code	PT97608
Hospital Revenue Code	420
Min. Negotiated Rate	$24.26
Max. Negotiated Rate	$918.59
Rate for Payer: AlohaCare Medicaid	$473.50
Rate for Payer: Cash Price	$615.55
Rate for Payer: Cash Price	$615.55
Rate for Payer: Hawaii Western Management Group Commercial	$899.65
Rate for Payer: Health Management Network Commercial	$804.95
Rate for Payer: Kaiser Permanente Commercial	$852.30
Rate for Payer: Kaiser Permanente Medicaid	$482.97
Rate for Payer: MDX Hawaii PPO	$918.59
Rate for Payer: UnitedHealthcare Medicaid	$24.26
Rate for Payer: University Health Alliance Commercial	$690.27

Neg Pressure Wound TX > 50cm

Facility

$947.00

Service Code	HCPCS 97608 GO
Hospital Charge Code	OT97608
Hospital Revenue Code	430
Min. Negotiated Rate	$804.95
Max. Negotiated Rate	$918.59
Rate for Payer: Cash Price	$615.55
Rate for Payer: Health Management Network Commercial	$804.95
Rate for Payer: Kaiser Permanente Commercial	$852.30
Rate for Payer: MDX Hawaii PPO	$918.59

Neg Pressure Wound TX > 50cm

Facility

$947.00

Service Code	HCPCS 97608 GO
Hospital Charge Code	OT97608
Hospital Revenue Code	430
Min. Negotiated Rate	$24.26
Max. Negotiated Rate	$918.59
Rate for Payer: AlohaCare Medicaid	$473.50
Rate for Payer: Cash Price	$615.55
Rate for Payer: Cash Price	$615.55
Rate for Payer: Hawaii Western Management Group Commercial	$899.65
Rate for Payer: Health Management Network Commercial	$804.95
Rate for Payer: Kaiser Permanente Commercial	$852.30
Rate for Payer: Kaiser Permanente Medicaid	$482.97
Rate for Payer: MDX Hawaii PPO	$918.59
Rate for Payer: UnitedHealthcare Medicaid	$24.26
Rate for Payer: University Health Alliance Commercial	$690.27

Neg Pressure Wound TX > 50cm

Facility

$947.00

Service Code	HCPCS 97608 GP
Hospital Charge Code	PT97608
Hospital Revenue Code	420
Min. Negotiated Rate	$804.95
Max. Negotiated Rate	$918.59
Rate for Payer: Cash Price	$615.55
Rate for Payer: Health Management Network Commercial	$804.95
Rate for Payer: Kaiser Permanente Commercial	$852.30
Rate for Payer: MDX Hawaii PPO	$918.59

NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY

Facility

$64,422.04

Service Code	MSDRG 789
Min. Negotiated Rate	$18,197.16
Max. Negotiated Rate	$64,422.04
Rate for Payer: AlohaCare Medicare	$18,197.16
Rate for Payer: Hawaii Medical Service Association Commercial	$64,422.04
Rate for Payer: Hawaii Medical Service Association Medicare	$18,197.16
Rate for Payer: Humana Medicare	$18,197.16
Rate for Payer: Kaiser Permanente Medicare	$18,197.16
Rate for Payer: Ohana Health Plan Medicare	$18,197.16
Rate for Payer: UnitedHealthcare Medicare	$18,197.16

NEONATE WITH OTHER SIGNIFICANT PROBLEMS

Facility

$14,981.36

Service Code	MSDRG 794
Min. Negotiated Rate	$4,029.34
Max. Negotiated Rate	$14,981.36
Rate for Payer: AlohaCare Medicare	$14,981.36
Rate for Payer: Hawaii Medical Service Association Commercial	$4,029.34
Rate for Payer: Hawaii Medical Service Association Medicare	$14,981.36
Rate for Payer: Humana Medicare	$14,981.36
Rate for Payer: Kaiser Permanente Medicare	$14,981.36
Rate for Payer: Ohana Health Plan Medicare	$14,981.36
Rate for Payer: UnitedHealthcare Medicare	$14,981.36

NERVOUS SYSTEM NEOPLASMS WITH MCC

Facility

$23,915.32

Service Code	MSDRG 054
Min. Negotiated Rate	$15,483.97
Max. Negotiated Rate	$23,915.32
Rate for Payer: AlohaCare Medicare	$15,483.97
Rate for Payer: Hawaii Medical Service Association Commercial	$23,915.32
Rate for Payer: Hawaii Medical Service Association Medicare	$15,483.97
Rate for Payer: Humana Medicare	$15,483.97
Rate for Payer: Kaiser Permanente Medicare	$15,483.97
Rate for Payer: Ohana Health Plan Medicare	$15,483.97
Rate for Payer: UnitedHealthcare Medicare	$15,483.97

NERVOUS SYSTEM NEOPLASMS WITHOUT MCC

Facility

$23,678.30

Service Code	MSDRG 055
Min. Negotiated Rate	$10,484.35
Max. Negotiated Rate	$23,678.30
Rate for Payer: AlohaCare Medicare	$10,484.35
Rate for Payer: Hawaii Medical Service Association Commercial	$23,678.30
Rate for Payer: Hawaii Medical Service Association Medicare	$10,484.35
Rate for Payer: Humana Medicare	$10,484.35
Rate for Payer: Kaiser Permanente Medicare	$10,484.35
Rate for Payer: Ohana Health Plan Medicare	$10,484.35
Rate for Payer: UnitedHealthcare Medicare	$10,484.35

NEUROLOGICAL EYE DISORDERS

Facility

$16,638.80

Service Code	MSDRG 123
Min. Negotiated Rate	$8,306.31
Max. Negotiated Rate	$16,638.80
Rate for Payer: AlohaCare Medicare	$8,306.31
Rate for Payer: Hawaii Medical Service Association Commercial	$16,638.80
Rate for Payer: Hawaii Medical Service Association Medicare	$8,306.31
Rate for Payer: Humana Medicare	$8,306.31
Rate for Payer: Kaiser Permanente Medicare	$8,306.31
Rate for Payer: Ohana Health Plan Medicare	$8,306.31
Rate for Payer: UnitedHealthcare Medicare	$8,306.31

Neuromuscular re-education

Facility

$215.00

Service Code	HCPCS 97112 GN
Hospital Charge Code	ST97112
Hospital Revenue Code	440
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$139.75
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: MDX Hawaii PPO	$208.55

Neuromuscular re-education

Facility

$215.00

Service Code	HCPCS 97112 GN
Hospital Charge Code	ST97112
Hospital Revenue Code	440
Min. Negotiated Rate	$18.58
Max. Negotiated Rate	$208.55
Rate for Payer: AlohaCare Medicaid	$107.50
Rate for Payer: Cash Price	$139.75
Rate for Payer: Cash Price	$139.75
Rate for Payer: Hawaii Western Management Group Commercial	$204.25
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: Kaiser Permanente Medicaid	$109.65
Rate for Payer: MDX Hawaii PPO	$208.55
Rate for Payer: UnitedHealthcare Medicaid	$18.58
Rate for Payer: University Health Alliance Commercial	$156.71

Neuromuscular Re-Education

Facility

$215.00

Service Code	HCPCS 97112 GO
Hospital Charge Code	OT97112
Hospital Revenue Code	430
Min. Negotiated Rate	$18.58
Max. Negotiated Rate	$208.55
Rate for Payer: AlohaCare Medicaid	$107.50
Rate for Payer: Cash Price	$139.75
Rate for Payer: Cash Price	$139.75
Rate for Payer: Hawaii Western Management Group Commercial	$204.25
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: Kaiser Permanente Medicaid	$109.65
Rate for Payer: MDX Hawaii PPO	$208.55
Rate for Payer: UnitedHealthcare Medicaid	$18.58
Rate for Payer: University Health Alliance Commercial	$156.71

Neuromuscular Re-Education

Facility

$215.00

Service Code	HCPCS 97112 GO
Hospital Charge Code	OT97112
Hospital Revenue Code	430
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$139.75
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: MDX Hawaii PPO	$208.55

Neuro Muscular re education

Facility

$215.00

Service Code	HCPCS 97112 GP
Hospital Charge Code	PT97112
Hospital Revenue Code	420
Min. Negotiated Rate	$18.58
Max. Negotiated Rate	$208.55
Rate for Payer: AlohaCare Medicaid	$107.50
Rate for Payer: Cash Price	$139.75
Rate for Payer: Cash Price	$139.75
Rate for Payer: Hawaii Western Management Group Commercial	$204.25
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: Kaiser Permanente Medicaid	$109.65
Rate for Payer: MDX Hawaii PPO	$208.55
Rate for Payer: UnitedHealthcare Medicaid	$18.58
Rate for Payer: University Health Alliance Commercial	$156.71

Neuro Muscular re education

Facility

$215.00

Service Code	HCPCS 97112 GP
Hospital Charge Code	PT97112
Hospital Revenue Code	420
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$139.75
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: MDX Hawaii PPO	$208.55

NEUROSES EXCEPT DEPRESSIVE

Facility

$11,018.51

Service Code	MSDRG 882
Min. Negotiated Rate	$9,528.20
Max. Negotiated Rate	$11,018.51
Rate for Payer: AlohaCare Medicare	$11,018.51
Rate for Payer: Hawaii Medical Service Association Commercial	$9,528.20
Rate for Payer: Hawaii Medical Service Association Medicare	$11,018.51
Rate for Payer: Humana Medicare	$11,018.51
Rate for Payer: Kaiser Permanente Medicare	$11,018.51
Rate for Payer: Ohana Health Plan Medicare	$11,018.51
Rate for Payer: UnitedHealthcare Medicare	$11,018.51

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC

Facility

$37,543.97

Service Code	MSDRG 098
Min. Negotiated Rate	$23,052.90
Max. Negotiated Rate	$37,543.97
Rate for Payer: AlohaCare Medicare	$23,052.90
Rate for Payer: Hawaii Medical Service Association Commercial	$37,543.97
Rate for Payer: Hawaii Medical Service Association Medicare	$23,052.90
Rate for Payer: Humana Medicare	$23,052.90
Rate for Payer: Kaiser Permanente Medicare	$23,052.90
Rate for Payer: Ohana Health Plan Medicare	$23,052.90
Rate for Payer: UnitedHealthcare Medicare	$23,052.90

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC

Facility

$37,543.97

Service Code	MSDRG 097
Min. Negotiated Rate	$36,031.41
Max. Negotiated Rate	$37,543.97
Rate for Payer: AlohaCare Medicare	$36,031.41
Rate for Payer: Hawaii Medical Service Association Commercial	$37,543.97
Rate for Payer: Hawaii Medical Service Association Medicare	$36,031.41
Rate for Payer: Humana Medicare	$36,031.41
Rate for Payer: Kaiser Permanente Medicare	$36,031.41
Rate for Payer: Ohana Health Plan Medicare	$36,031.41
Rate for Payer: UnitedHealthcare Medicare	$36,031.41

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$37,543.97

Service Code	MSDRG 099
Min. Negotiated Rate	$13,862.76
Max. Negotiated Rate	$37,543.97
Rate for Payer: AlohaCare Medicare	$13,862.76
Rate for Payer: Hawaii Medical Service Association Commercial	$37,543.97
Rate for Payer: Hawaii Medical Service Association Medicare	$13,862.76
Rate for Payer: Humana Medicare	$13,862.76
Rate for Payer: Kaiser Permanente Medicare	$13,862.76
Rate for Payer: Ohana Health Plan Medicare	$13,862.76
Rate for Payer: UnitedHealthcare Medicare	$13,862.76

NON-EXTENSIVE BURNS

Facility

$20,737.87

Service Code	MSDRG 935
Min. Negotiated Rate	$20,737.87
Max. Negotiated Rate	$20,737.87
Rate for Payer: AlohaCare Medicare	$20,737.87
Rate for Payer: Hawaii Medical Service Association Medicare	$20,737.87
Rate for Payer: Humana Medicare	$20,737.87
Rate for Payer: Kaiser Permanente Medicare	$20,737.87
Rate for Payer: Ohana Health Plan Medicare	$20,737.87
Rate for Payer: UnitedHealthcare Medicare	$20,737.87

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$38,018.01

Service Code	MSDRG 988
Min. Negotiated Rate	$16,634.09
Max. Negotiated Rate	$38,018.01
Rate for Payer: AlohaCare Medicare	$16,634.09
Rate for Payer: Hawaii Medical Service Association Commercial	$38,018.01
Rate for Payer: Hawaii Medical Service Association Medicare	$16,634.09
Rate for Payer: Humana Medicare	$16,634.09
Rate for Payer: Kaiser Permanente Medicare	$16,634.09
Rate for Payer: Ohana Health Plan Medicare	$16,634.09
Rate for Payer: UnitedHealthcare Medicare	$16,634.09

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$38,018.01

Service Code	MSDRG 987
Min. Negotiated Rate	$34,223.94
Max. Negotiated Rate	$38,018.01
Rate for Payer: AlohaCare Medicare	$34,223.94
Rate for Payer: Hawaii Medical Service Association Commercial	$38,018.01
Rate for Payer: Hawaii Medical Service Association Medicare	$34,223.94
Rate for Payer: Humana Medicare	$34,223.94
Rate for Payer: Kaiser Permanente Medicare	$34,223.94
Rate for Payer: Ohana Health Plan Medicare	$34,223.94
Rate for Payer: UnitedHealthcare Medicare	$34,223.94

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$38,018.01

Service Code	MSDRG 989
Min. Negotiated Rate	$12,254.38
Max. Negotiated Rate	$38,018.01
Rate for Payer: AlohaCare Medicare	$12,254.38
Rate for Payer: Hawaii Medical Service Association Commercial	$38,018.01
Rate for Payer: Hawaii Medical Service Association Medicare	$12,254.38
Rate for Payer: Humana Medicare	$12,254.38
Rate for Payer: Kaiser Permanente Medicare	$12,254.38
Rate for Payer: Ohana Health Plan Medicare	$12,254.38
Rate for Payer: UnitedHealthcare Medicare	$12,254.38

NON-MALIGNANT BREAST DISORDERS WITH CC/MCC

Facility

$15,998.85

Service Code	MSDRG 600
Min. Negotiated Rate	$10,701.16
Max. Negotiated Rate	$15,998.85
Rate for Payer: AlohaCare Medicare	$10,701.16
Rate for Payer: Hawaii Medical Service Association Commercial	$15,998.85
Rate for Payer: Hawaii Medical Service Association Medicare	$10,701.16
Rate for Payer: Humana Medicare	$10,701.16
Rate for Payer: Kaiser Permanente Medicare	$10,701.16
Rate for Payer: Ohana Health Plan Medicare	$10,701.16
Rate for Payer: UnitedHealthcare Medicare	$10,701.16

NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$15,998.85

Service Code	MSDRG 601
Min. Negotiated Rate	$6,398.32
Max. Negotiated Rate	$15,998.85
Rate for Payer: AlohaCare Medicare	$6,398.32
Rate for Payer: Hawaii Medical Service Association Commercial	$15,998.85
Rate for Payer: Hawaii Medical Service Association Medicare	$6,398.32
Rate for Payer: Humana Medicare	$6,398.32
Rate for Payer: Kaiser Permanente Medicare	$6,398.32
Rate for Payer: Ohana Health Plan Medicare	$6,398.32
Rate for Payer: UnitedHealthcare Medicare	$6,398.32

Know your out-of-pocket cost for care.

All Charges