Leahi Hospital

All Charges

Charge

Type

Setting

Price

PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC

Facility

$71,580.04

Service Code	MSDRG 242
Min. Negotiated Rate	$31,902.02
Max. Negotiated Rate	$71,580.04
Rate for Payer: AlohaCare Medicare	$31,902.02
Rate for Payer: Hawaii Medical Service Association Commercial	$71,580.04
Rate for Payer: Hawaii Medical Service Association Medicare	$31,902.02
Rate for Payer: Humana Medicare	$31,902.02
Rate for Payer: Kaiser Permanente Medicare	$31,902.02
Rate for Payer: Ohana Health Plan Medicare	$31,902.02
Rate for Payer: UnitedHealthcare Medicare	$31,902.02

PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC

Facility

$43,967.21

Service Code	MSDRG 244
Min. Negotiated Rate	$18,249.39
Max. Negotiated Rate	$43,967.21
Rate for Payer: AlohaCare Medicare	$18,249.39
Rate for Payer: Hawaii Medical Service Association Commercial	$43,967.21
Rate for Payer: Hawaii Medical Service Association Medicare	$18,249.39
Rate for Payer: Humana Medicare	$18,249.39
Rate for Payer: Kaiser Permanente Medicare	$18,249.39
Rate for Payer: Ohana Health Plan Medicare	$18,249.39
Rate for Payer: UnitedHealthcare Medicare	$18,249.39

Pfizer - Comirnaty Single

Facility

$341.00

Service Code	HCPCS 91320
Hospital Charge Code	Pfi-Com
Hospital Revenue Code	636
Min. Negotiated Rate	$147.69
Max. Negotiated Rate	$330.77
Rate for Payer: AlohaCare Medicaid	$170.50
Rate for Payer: Cash Price	$221.65
Rate for Payer: Cash Price	$221.65
Rate for Payer: Hawaii Medical Service Association ABD	$147.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$147.69
Rate for Payer: Hawaii Western Management Group Commercial	$323.95
Rate for Payer: Health Management Network Commercial	$289.85
Rate for Payer: Kaiser Permanente Commercial	$306.90
Rate for Payer: Kaiser Permanente Medicaid	$173.91
Rate for Payer: MDX Hawaii PPO	$330.77
Rate for Payer: UnitedHealthcare Medicaid	$204.60
Rate for Payer: University Health Alliance Commercial	$248.55

Pfizer - Comirnaty Single

Facility

$341.00

Service Code	HCPCS 91320
Hospital Charge Code	Pfi-Com
Hospital Revenue Code	636
Min. Negotiated Rate	$289.85
Max. Negotiated Rate	$330.77
Rate for Payer: Cash Price	$221.65
Rate for Payer: Health Management Network Commercial	$289.85
Rate for Payer: Kaiser Permanente Commercial	$306.90
Rate for Payer: MDX Hawaii PPO	$330.77

Phone E/M Phys 11-20 min

Professional

Both

$126.00

Service Code	HCPCS 99442
Hospital Charge Code	99442
Min. Negotiated Rate	$38.68
Max. Negotiated Rate	$107.10
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cash Price	$81.90
Rate for Payer: Hawaii Western Management Group Commercial	$38.68
Rate for Payer: Health Management Network Commercial	$107.10

Phosphorous blood

Facility

$82.00

Service Code	HCPCS 84100
Hospital Charge Code	84100
Hospital Revenue Code	301
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$79.54
Rate for Payer: AlohaCare Medicaid	$41.00
Rate for Payer: Cash Price	$53.30
Rate for Payer: Cash Price	$53.30
Rate for Payer: Hawaii Medical Service Association ABD	$6.56
Rate for Payer: Hawaii Medical Service Association Commercial	$5.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.89
Rate for Payer: Hawaii Western Management Group Commercial	$4.74
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: Kaiser Permanente Medicaid	$41.82
Rate for Payer: MDX Hawaii PPO	$79.54
Rate for Payer: UnitedHealthcare Medicaid	$6.56
Rate for Payer: University Health Alliance Commercial	$12.27

Phosphorous blood

Facility

$82.00

Service Code	HCPCS 84100
Hospital Charge Code	84100
Hospital Revenue Code	301
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$53.30
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: MDX Hawaii PPO	$79.54

Platelet count auto

Facility

$71.00

Service Code	HCPCS 85049
Hospital Charge Code	85049
Hospital Revenue Code	305
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Hawaii Medical Service Association ABD	$6.25
Rate for Payer: Hawaii Medical Service Association Commercial	$5.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.56
Rate for Payer: Hawaii Western Management Group Commercial	$4.48
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: UnitedHealthcare Medicaid	$6.25
Rate for Payer: University Health Alliance Commercial	$11.56

Platelet count auto

Facility

$71.00

Service Code	HCPCS 85049
Hospital Charge Code	85049
Hospital Revenue Code	305
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

PLEURAL EFFUSION WITH CC

Facility

$27,565.43

Service Code	MSDRG 187
Min. Negotiated Rate	$10,183.76
Max. Negotiated Rate	$27,565.43
Rate for Payer: AlohaCare Medicare	$10,183.76
Rate for Payer: Hawaii Medical Service Association Commercial	$27,565.43
Rate for Payer: Hawaii Medical Service Association Medicare	$10,183.76
Rate for Payer: Humana Medicare	$10,183.76
Rate for Payer: Kaiser Permanente Medicare	$10,183.76
Rate for Payer: Ohana Health Plan Medicare	$10,183.76
Rate for Payer: UnitedHealthcare Medicare	$10,183.76

PLEURAL EFFUSION WITH MCC

Facility

$28,205.38

Service Code	MSDRG 186
Min. Negotiated Rate	$15,795.40
Max. Negotiated Rate	$28,205.38
Rate for Payer: AlohaCare Medicare	$15,795.40
Rate for Payer: Hawaii Medical Service Association Commercial	$28,205.38
Rate for Payer: Hawaii Medical Service Association Medicare	$15,795.40
Rate for Payer: Humana Medicare	$15,795.40
Rate for Payer: Kaiser Permanente Medicare	$15,795.40
Rate for Payer: Ohana Health Plan Medicare	$15,795.40
Rate for Payer: UnitedHealthcare Medicare	$15,795.40

PLEURAL EFFUSION WITHOUT CC/MCC

Facility

$22,516.90

Service Code	MSDRG 188
Min. Negotiated Rate	$7,504.09
Max. Negotiated Rate	$22,516.90
Rate for Payer: AlohaCare Medicare	$7,504.09
Rate for Payer: Hawaii Medical Service Association Commercial	$22,516.90
Rate for Payer: Hawaii Medical Service Association Medicare	$7,504.09
Rate for Payer: Humana Medicare	$7,504.09
Rate for Payer: Kaiser Permanente Medicare	$7,504.09
Rate for Payer: Ohana Health Plan Medicare	$7,504.09
Rate for Payer: UnitedHealthcare Medicare	$7,504.09

Pneumococcal Conjugate Vaccine, PCV21

Facility

$562.00

Service Code	HCPCS 90684
Hospital Charge Code	PNEUM-21
Hospital Revenue Code	636
Min. Negotiated Rate	$477.70
Max. Negotiated Rate	$545.14
Rate for Payer: Cash Price	$365.30
Rate for Payer: Health Management Network Commercial	$477.70
Rate for Payer: Kaiser Permanente Commercial	$505.80
Rate for Payer: MDX Hawaii PPO	$545.14

Pneumococcal Conjugate Vaccine, PCV21

Facility

$562.00

Service Code	HCPCS 90684
Hospital Charge Code	PNEUM-21
Hospital Revenue Code	636
Min. Negotiated Rate	$281.00
Max. Negotiated Rate	$545.14
Rate for Payer: AlohaCare Medicaid	$281.00
Rate for Payer: Cash Price	$365.30
Rate for Payer: Cash Price	$365.30
Rate for Payer: Hawaii Medical Service Association ABD	$327.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$327.89
Rate for Payer: Hawaii Western Management Group Commercial	$533.90
Rate for Payer: Health Management Network Commercial	$477.70
Rate for Payer: Kaiser Permanente Commercial	$505.80
Rate for Payer: Kaiser Permanente Medicaid	$286.62
Rate for Payer: MDX Hawaii PPO	$545.14
Rate for Payer: UnitedHealthcare Medicaid	$337.20
Rate for Payer: University Health Alliance Commercial	$409.64

PNEUMOCOCCAL CONJ VACC PCV15 vaccine IM

Facility

$337.00

Service Code	HCPCS 90671
Hospital Charge Code	PNEUM-15
Hospital Revenue Code	636
Min. Negotiated Rate	$286.45
Max. Negotiated Rate	$326.89
Rate for Payer: Cash Price	$219.05
Rate for Payer: Health Management Network Commercial	$286.45
Rate for Payer: Kaiser Permanente Commercial	$303.30
Rate for Payer: MDX Hawaii PPO	$326.89

PNEUMOCOCCAL CONJ VACC PCV15 vaccine IM

Facility

$337.00

Service Code	HCPCS 90671
Hospital Charge Code	PNEUM-15
Hospital Revenue Code	636
Min. Negotiated Rate	$168.50
Max. Negotiated Rate	$326.89
Rate for Payer: AlohaCare Medicaid	$168.50
Rate for Payer: Cash Price	$219.05
Rate for Payer: Cash Price	$219.05
Rate for Payer: Hawaii Medical Service Association ABD	$253.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$253.56
Rate for Payer: Hawaii Western Management Group Commercial	$320.15
Rate for Payer: Health Management Network Commercial	$286.45
Rate for Payer: Kaiser Permanente Commercial	$303.30
Rate for Payer: Kaiser Permanente Medicaid	$171.87
Rate for Payer: MDX Hawaii PPO	$326.89
Rate for Payer: UnitedHealthcare Medicaid	$202.20
Rate for Payer: University Health Alliance Commercial	$245.64

PNEUMOCOCCAL CONJ VACC PCV20 vaccine IM

Facility

$413.00

Service Code	HCPCS 90677
Hospital Charge Code	PNEUM-20
Hospital Revenue Code	636
Min. Negotiated Rate	$206.50
Max. Negotiated Rate	$400.61
Rate for Payer: AlohaCare Medicaid	$206.50
Rate for Payer: Cash Price	$268.45
Rate for Payer: Cash Price	$268.45
Rate for Payer: Hawaii Medical Service Association ABD	$298.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$298.04
Rate for Payer: Hawaii Western Management Group Commercial	$392.35
Rate for Payer: Health Management Network Commercial	$351.05
Rate for Payer: Kaiser Permanente Commercial	$371.70
Rate for Payer: Kaiser Permanente Medicaid	$210.63
Rate for Payer: MDX Hawaii PPO	$400.61
Rate for Payer: UnitedHealthcare Medicaid	$247.80
Rate for Payer: University Health Alliance Commercial	$301.04

PNEUMOCOCCAL CONJ VACC PCV20 vaccine IM

Facility

$413.00

Service Code	HCPCS 90677
Hospital Charge Code	PNEUM-20
Hospital Revenue Code	636
Min. Negotiated Rate	$351.05
Max. Negotiated Rate	$400.61
Rate for Payer: Cash Price	$268.45
Rate for Payer: Health Management Network Commercial	$351.05
Rate for Payer: Kaiser Permanente Commercial	$371.70
Rate for Payer: MDX Hawaii PPO	$400.61

Pneumococcal Vaccine

Facility

$213.00

Service Code	HCPCS 90732
Hospital Charge Code	PNEUM
Hospital Revenue Code	636
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$206.61
Rate for Payer: AlohaCare Medicaid	$106.50
Rate for Payer: Cash Price	$138.45
Rate for Payer: Cash Price	$138.45
Rate for Payer: Hawaii Medical Service Association ABD	$133.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$133.47
Rate for Payer: Hawaii Western Management Group Commercial	$202.35
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: Kaiser Permanente Commercial	$191.70
Rate for Payer: Kaiser Permanente Medicaid	$108.63
Rate for Payer: MDX Hawaii PPO	$206.61
Rate for Payer: UnitedHealthcare Medicaid	$127.80
Rate for Payer: University Health Alliance Commercial	$155.26

Pneumococcal Vaccine

Facility

$213.00

Service Code	HCPCS 90732
Hospital Charge Code	PNEUM
Hospital Revenue Code	636
Min. Negotiated Rate	$181.05
Max. Negotiated Rate	$206.61
Rate for Payer: Cash Price	$138.45
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: Kaiser Permanente Commercial	$191.70
Rate for Payer: MDX Hawaii PPO	$206.61

PNEUMOTHORAX WITH CC

Facility

$17,373.57

Service Code	MSDRG 200
Min. Negotiated Rate	$11,269.82
Max. Negotiated Rate	$17,373.57
Rate for Payer: AlohaCare Medicare	$11,269.82
Rate for Payer: Hawaii Medical Service Association Commercial	$17,373.57
Rate for Payer: Hawaii Medical Service Association Medicare	$11,269.82
Rate for Payer: Humana Medicare	$11,269.82
Rate for Payer: Kaiser Permanente Medicare	$11,269.82
Rate for Payer: Ohana Health Plan Medicare	$11,269.82
Rate for Payer: UnitedHealthcare Medicare	$11,269.82

PNEUMOTHORAX WITH MCC

Facility

$18,321.65

Service Code	MSDRG 199
Min. Negotiated Rate	$17,821.66
Max. Negotiated Rate	$18,321.65
Rate for Payer: AlohaCare Medicare	$17,821.66
Rate for Payer: Hawaii Medical Service Association Commercial	$18,321.65
Rate for Payer: Hawaii Medical Service Association Medicare	$17,821.66
Rate for Payer: Humana Medicare	$17,821.66
Rate for Payer: Kaiser Permanente Medicare	$17,821.66
Rate for Payer: Ohana Health Plan Medicare	$17,821.66
Rate for Payer: UnitedHealthcare Medicare	$17,821.66

PNEUMOTHORAX WITHOUT CC/MCC

Facility

$13,770.86

Service Code	MSDRG 201
Min. Negotiated Rate	$7,483.39
Max. Negotiated Rate	$13,770.86
Rate for Payer: AlohaCare Medicare	$7,483.39
Rate for Payer: Hawaii Medical Service Association Commercial	$13,770.86
Rate for Payer: Hawaii Medical Service Association Medicare	$7,483.39
Rate for Payer: Humana Medicare	$7,483.39
Rate for Payer: Kaiser Permanente Medicare	$7,483.39
Rate for Payer: Ohana Health Plan Medicare	$7,483.39
Rate for Payer: UnitedHealthcare Medicare	$7,483.39

POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC

Facility

$20,597.04

Service Code	MSDRG 917
Min. Negotiated Rate	$15,892.97
Max. Negotiated Rate	$20,597.04
Rate for Payer: AlohaCare Medicare	$15,892.97
Rate for Payer: Hawaii Medical Service Association Commercial	$20,597.04
Rate for Payer: Hawaii Medical Service Association Medicare	$15,892.97
Rate for Payer: Humana Medicare	$15,892.97
Rate for Payer: Kaiser Permanente Medicare	$15,892.97
Rate for Payer: Ohana Health Plan Medicare	$15,892.97
Rate for Payer: UnitedHealthcare Medicare	$15,892.97

POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC

Facility

$15,714.43

Service Code	MSDRG 918
Min. Negotiated Rate	$8,882.86
Max. Negotiated Rate	$15,714.43
Rate for Payer: AlohaCare Medicare	$8,882.86
Rate for Payer: Hawaii Medical Service Association Commercial	$15,714.43
Rate for Payer: Hawaii Medical Service Association Medicare	$8,882.86
Rate for Payer: Humana Medicare	$8,882.86
Rate for Payer: Kaiser Permanente Medicare	$8,882.86
Rate for Payer: Ohana Health Plan Medicare	$8,882.86
Rate for Payer: UnitedHealthcare Medicare	$8,882.86

Know your out-of-pocket cost for care.

All Charges