Leahi Hospital

All Charges

Charge

Type

Setting

Price

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC

Facility

$42,260.67

Service Code	MSDRG 804
Min. Negotiated Rate	$13,799.70
Max. Negotiated Rate	$42,260.67
Rate for Payer: AlohaCare Medicare	$13,799.70
Rate for Payer: Hawaii Medical Service Association Commercial	$42,260.67
Rate for Payer: Hawaii Medical Service Association Medicare	$13,799.70
Rate for Payer: Humana Medicare	$13,799.70
Rate for Payer: Kaiser Permanente Medicare	$13,799.70
Rate for Payer: Ohana Health Plan Medicare	$13,799.70
Rate for Payer: UnitedHealthcare Medicare	$13,799.70

OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC

Facility

$20,454.83

Service Code	MSDRG 205
Min. Negotiated Rate	$18,480.99
Max. Negotiated Rate	$20,454.83
Rate for Payer: AlohaCare Medicare	$18,480.99
Rate for Payer: Hawaii Medical Service Association Commercial	$20,454.83
Rate for Payer: Hawaii Medical Service Association Medicare	$18,480.99
Rate for Payer: Humana Medicare	$18,480.99
Rate for Payer: Kaiser Permanente Medicare	$18,480.99
Rate for Payer: Ohana Health Plan Medicare	$18,480.99
Rate for Payer: UnitedHealthcare Medicare	$18,480.99

OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC

Facility

$17,634.29

Service Code	MSDRG 206
Min. Negotiated Rate	$9,710.71
Max. Negotiated Rate	$17,634.29
Rate for Payer: AlohaCare Medicare	$9,710.71
Rate for Payer: Hawaii Medical Service Association Commercial	$17,634.29
Rate for Payer: Hawaii Medical Service Association Medicare	$9,710.71
Rate for Payer: Humana Medicare	$9,710.71
Rate for Payer: Kaiser Permanente Medicare	$9,710.71
Rate for Payer: Ohana Health Plan Medicare	$9,710.71
Rate for Payer: UnitedHealthcare Medicare	$9,710.71

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC

Facility

$60,511.21

Service Code	MSDRG 167
Min. Negotiated Rate	$18,208.97
Max. Negotiated Rate	$60,511.21
Rate for Payer: AlohaCare Medicare	$18,208.97
Rate for Payer: Hawaii Medical Service Association Commercial	$60,511.21
Rate for Payer: Hawaii Medical Service Association Medicare	$18,208.97
Rate for Payer: Humana Medicare	$18,208.97
Rate for Payer: Kaiser Permanente Medicare	$18,208.97
Rate for Payer: Ohana Health Plan Medicare	$18,208.97
Rate for Payer: UnitedHealthcare Medicare	$18,208.97

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC

Facility

$63,497.66

Service Code	MSDRG 166
Min. Negotiated Rate	$37,272.21
Max. Negotiated Rate	$63,497.66
Rate for Payer: AlohaCare Medicare	$37,272.21
Rate for Payer: Hawaii Medical Service Association Commercial	$63,497.66
Rate for Payer: Hawaii Medical Service Association Medicare	$37,272.21
Rate for Payer: Humana Medicare	$37,272.21
Rate for Payer: Kaiser Permanente Medicare	$37,272.21
Rate for Payer: Ohana Health Plan Medicare	$37,272.21
Rate for Payer: UnitedHealthcare Medicare	$37,272.21

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$43,232.45

Service Code	MSDRG 168
Min. Negotiated Rate	$13,902.19
Max. Negotiated Rate	$43,232.45
Rate for Payer: AlohaCare Medicare	$13,902.19
Rate for Payer: Hawaii Medical Service Association Commercial	$43,232.45
Rate for Payer: Hawaii Medical Service Association Medicare	$13,902.19
Rate for Payer: Humana Medicare	$13,902.19
Rate for Payer: Kaiser Permanente Medicare	$13,902.19
Rate for Payer: Ohana Health Plan Medicare	$13,902.19
Rate for Payer: UnitedHealthcare Medicare	$13,902.19

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC

Facility

$29,295.67

Service Code	MSDRG 580
Min. Negotiated Rate	$17,465.88
Max. Negotiated Rate	$29,295.67
Rate for Payer: AlohaCare Medicare	$17,465.88
Rate for Payer: Hawaii Medical Service Association Commercial	$29,295.67
Rate for Payer: Hawaii Medical Service Association Medicare	$17,465.88
Rate for Payer: Humana Medicare	$17,465.88
Rate for Payer: Kaiser Permanente Medicare	$17,465.88
Rate for Payer: Ohana Health Plan Medicare	$17,465.88
Rate for Payer: UnitedHealthcare Medicare	$17,465.88

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC

Facility

$46,811.45

Service Code	MSDRG 579
Min. Negotiated Rate	$32,352.40
Max. Negotiated Rate	$46,811.45
Rate for Payer: AlohaCare Medicare	$32,352.40
Rate for Payer: Hawaii Medical Service Association Commercial	$46,811.45
Rate for Payer: Hawaii Medical Service Association Medicare	$32,352.40
Rate for Payer: Humana Medicare	$32,352.40
Rate for Payer: Kaiser Permanente Medicare	$32,352.40
Rate for Payer: Ohana Health Plan Medicare	$32,352.40
Rate for Payer: UnitedHealthcare Medicare	$32,352.40

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC

Facility

$24,057.53

Service Code	MSDRG 581
Min. Negotiated Rate	$14,658.10
Max. Negotiated Rate	$24,057.53
Rate for Payer: AlohaCare Medicare	$14,658.10
Rate for Payer: Hawaii Medical Service Association Commercial	$24,057.53
Rate for Payer: Hawaii Medical Service Association Medicare	$14,658.10
Rate for Payer: Humana Medicare	$14,658.10
Rate for Payer: Kaiser Permanente Medicare	$14,658.10
Rate for Payer: Ohana Health Plan Medicare	$14,658.10
Rate for Payer: UnitedHealthcare Medicare	$14,658.10

OTHER VASCULAR PROCEDURES WITH CC

Facility

$67,550.70

Service Code	MSDRG 253
Min. Negotiated Rate	$26,016.40
Max. Negotiated Rate	$67,550.70
Rate for Payer: AlohaCare Medicare	$26,016.40
Rate for Payer: Hawaii Medical Service Association Commercial	$67,550.70
Rate for Payer: Hawaii Medical Service Association Medicare	$26,016.40
Rate for Payer: Humana Medicare	$26,016.40
Rate for Payer: Kaiser Permanente Medicare	$26,016.40
Rate for Payer: Ohana Health Plan Medicare	$26,016.40
Rate for Payer: UnitedHealthcare Medicare	$26,016.40

OTHER VASCULAR PROCEDURES WITH MCC

Facility

$71,911.87

Service Code	MSDRG 252
Min. Negotiated Rate	$34,814.27
Max. Negotiated Rate	$71,911.87
Rate for Payer: AlohaCare Medicare	$34,814.27
Rate for Payer: Hawaii Medical Service Association Commercial	$71,911.87
Rate for Payer: Hawaii Medical Service Association Medicare	$34,814.27
Rate for Payer: Humana Medicare	$34,814.27
Rate for Payer: Kaiser Permanente Medicare	$34,814.27
Rate for Payer: Ohana Health Plan Medicare	$34,814.27
Rate for Payer: UnitedHealthcare Medicare	$34,814.27

OTHER VASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$48,826.12

Service Code	MSDRG 254
Min. Negotiated Rate	$17,995.11
Max. Negotiated Rate	$48,826.12
Rate for Payer: AlohaCare Medicare	$17,995.11
Rate for Payer: Hawaii Medical Service Association Commercial	$48,826.12
Rate for Payer: Hawaii Medical Service Association Medicare	$17,995.11
Rate for Payer: Humana Medicare	$17,995.11
Rate for Payer: Kaiser Permanente Medicare	$17,995.11
Rate for Payer: Ohana Health Plan Medicare	$17,995.11
Rate for Payer: UnitedHealthcare Medicare	$17,995.11

OTITIS MEDIA AND URI WITH MCC

Facility

$12,182.83

Service Code	MSDRG 152
Min. Negotiated Rate	$12,086.83
Max. Negotiated Rate	$12,182.83
Rate for Payer: AlohaCare Medicare	$12,086.83
Rate for Payer: Hawaii Medical Service Association Commercial	$12,182.83
Rate for Payer: Hawaii Medical Service Association Medicare	$12,086.83
Rate for Payer: Humana Medicare	$12,086.83
Rate for Payer: Kaiser Permanente Medicare	$12,086.83
Rate for Payer: Ohana Health Plan Medicare	$12,086.83
Rate for Payer: UnitedHealthcare Medicare	$12,086.83

OTITIS MEDIA AND URI WITHOUT MCC

Facility

$10,547.39

Service Code	MSDRG 153
Min. Negotiated Rate	$7,711.06
Max. Negotiated Rate	$10,547.39
Rate for Payer: AlohaCare Medicare	$7,711.06
Rate for Payer: Hawaii Medical Service Association Commercial	$10,547.39
Rate for Payer: Hawaii Medical Service Association Medicare	$7,711.06
Rate for Payer: Humana Medicare	$7,711.06
Rate for Payer: Kaiser Permanente Medicare	$7,711.06
Rate for Payer: Ohana Health Plan Medicare	$7,711.06
Rate for Payer: UnitedHealthcare Medicare	$7,711.06

OT Re-Eval Est Plan

Facility

$362.00

Service Code	HCPCS 97168
Hospital Charge Code	OT97168
Hospital Revenue Code	434
Min. Negotiated Rate	$74.97
Max. Negotiated Rate	$351.14
Rate for Payer: AlohaCare Medicaid	$181.00
Rate for Payer: Cash Price	$235.30
Rate for Payer: Cash Price	$235.30
Rate for Payer: Hawaii Western Management Group Commercial	$343.90
Rate for Payer: Health Management Network Commercial	$307.70
Rate for Payer: Kaiser Permanente Commercial	$325.80
Rate for Payer: Kaiser Permanente Medicaid	$184.62
Rate for Payer: MDX Hawaii PPO	$351.14
Rate for Payer: UnitedHealthcare Medicaid	$74.97
Rate for Payer: University Health Alliance Commercial	$263.86

OT Re-Eval Est Plan

Facility

$362.00

Service Code	HCPCS 97168
Hospital Charge Code	OT97168
Hospital Revenue Code	434
Min. Negotiated Rate	$307.70
Max. Negotiated Rate	$351.14
Rate for Payer: Cash Price	$235.30
Rate for Payer: Health Management Network Commercial	$307.70
Rate for Payer: Kaiser Permanente Commercial	$325.80
Rate for Payer: MDX Hawaii PPO	$351.14

OT Swallow Eval

Facility

$1,000.00

Service Code	HCPCS 92610 GO
Hospital Charge Code	OT92610
Hospital Revenue Code	434
Min. Negotiated Rate	$850.00
Max. Negotiated Rate	$970.00
Rate for Payer: Cash Price	$650.00
Rate for Payer: Health Management Network Commercial	$850.00
Rate for Payer: Kaiser Permanente Commercial	$900.00
Rate for Payer: MDX Hawaii PPO	$970.00

OT Swallow Eval

Facility

$1,000.00

Service Code	HCPCS 92610 GO
Hospital Charge Code	OT92610
Hospital Revenue Code	434
Min. Negotiated Rate	$88.36
Max. Negotiated Rate	$970.00
Rate for Payer: AlohaCare Medicaid	$500.00
Rate for Payer: Cash Price	$650.00
Rate for Payer: Cash Price	$650.00
Rate for Payer: Hawaii Western Management Group Commercial	$950.00
Rate for Payer: Health Management Network Commercial	$850.00
Rate for Payer: Kaiser Permanente Commercial	$900.00
Rate for Payer: Kaiser Permanente Medicaid	$510.00
Rate for Payer: MDX Hawaii PPO	$970.00
Rate for Payer: UnitedHealthcare Medicaid	$88.36
Rate for Payer: University Health Alliance Commercial	$728.90

PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC

Facility

$51,646.66

Service Code	MSDRG 406
Min. Negotiated Rate	$29,018.34
Max. Negotiated Rate	$51,646.66
Rate for Payer: AlohaCare Medicare	$29,018.34
Rate for Payer: Hawaii Medical Service Association Commercial	$51,646.66
Rate for Payer: Hawaii Medical Service Association Medicare	$29,018.34
Rate for Payer: Humana Medicare	$29,018.34
Rate for Payer: Kaiser Permanente Medicare	$29,018.34
Rate for Payer: Ohana Health Plan Medicare	$29,018.34
Rate for Payer: UnitedHealthcare Medicare	$29,018.34

PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC

Facility

$93,433.28

Service Code	MSDRG 405
Min. Negotiated Rate	$54,349.57
Max. Negotiated Rate	$93,433.28
Rate for Payer: AlohaCare Medicare	$54,349.57
Rate for Payer: Hawaii Medical Service Association Commercial	$93,433.28
Rate for Payer: Hawaii Medical Service Association Medicare	$54,349.57
Rate for Payer: Humana Medicare	$54,349.57
Rate for Payer: Kaiser Permanente Medicare	$54,349.57
Rate for Payer: Ohana Health Plan Medicare	$54,349.57
Rate for Payer: UnitedHealthcare Medicare	$54,349.57

PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC

Facility

$37,022.52

Service Code	MSDRG 407
Min. Negotiated Rate	$22,310.78
Max. Negotiated Rate	$37,022.52
Rate for Payer: AlohaCare Medicare	$22,310.78
Rate for Payer: Hawaii Medical Service Association Commercial	$37,022.52
Rate for Payer: Hawaii Medical Service Association Medicare	$22,310.78
Rate for Payer: Humana Medicare	$22,310.78
Rate for Payer: Kaiser Permanente Medicare	$22,310.78
Rate for Payer: Ohana Health Plan Medicare	$22,310.78
Rate for Payer: UnitedHealthcare Medicare	$22,310.78

PANCREAS TRANSPLANT

Facility

$71,154.91

Service Code	MSDRG 010
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$71,154.91
Rate for Payer: AlohaCare Medicare	$71,154.91
Rate for Payer: Hawaii Medical Service Association Medicare	$71,154.91
Rate for Payer: Kaiser Permanente Medicare	$71,154.91
Rate for Payer: Ohana Health Plan Medicare	$71,154.91
Rate for Payer: UnitedHealthcare Medicare	$71,154.91
Rate for Payer: University Health Alliance Commercial	$10,400.00

Paraffin bath, supervise

Facility

$48.00

Service Code	HCPCS 97018 GO
Hospital Charge Code	OT97018
Hospital Revenue Code	430
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$46.56
Rate for Payer: AlohaCare Medicaid	$24.00
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Hawaii Western Management Group Commercial	$45.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: UnitedHealthcare Medicaid	$6.82
Rate for Payer: University Health Alliance Commercial	$34.99

Paraffin bath, supervise

Facility

$48.00

Service Code	HCPCS 97018 GO
Hospital Charge Code	OT97018
Hospital Revenue Code	430
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$31.20
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: MDX Hawaii PPO	$46.56

PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC

Facility

$32,874.67

Service Code	MSDRG 543
Min. Negotiated Rate	$10,567.14
Max. Negotiated Rate	$32,874.67
Rate for Payer: AlohaCare Medicare	$10,567.14
Rate for Payer: Hawaii Medical Service Association Commercial	$32,874.67
Rate for Payer: Hawaii Medical Service Association Medicare	$10,567.14
Rate for Payer: Humana Medicare	$10,567.14
Rate for Payer: Kaiser Permanente Medicare	$10,567.14
Rate for Payer: Ohana Health Plan Medicare	$10,567.14
Rate for Payer: UnitedHealthcare Medicare	$10,567.14

Know your out-of-pocket cost for care.

All Charges