Leahi Hospital

All Charges

Charge

Type

Setting

Price

POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC

Facility

$21,545.12

Service Code	MSDRG 862
Min. Negotiated Rate	$18,409.05
Max. Negotiated Rate	$21,545.12
Rate for Payer: AlohaCare Medicare	$18,409.05
Rate for Payer: Hawaii Medical Service Association Commercial	$21,545.12
Rate for Payer: Hawaii Medical Service Association Medicare	$18,409.05
Rate for Payer: Humana Medicare	$18,409.05
Rate for Payer: Kaiser Permanente Medicare	$18,409.05
Rate for Payer: Ohana Health Plan Medicare	$18,409.05
Rate for Payer: UnitedHealthcare Medicare	$18,409.05

POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC

Facility

$21,545.12

Service Code	MSDRG 863
Min. Negotiated Rate	$10,270.48
Max. Negotiated Rate	$21,545.12
Rate for Payer: AlohaCare Medicare	$10,270.48
Rate for Payer: Hawaii Medical Service Association Commercial	$21,545.12
Rate for Payer: Hawaii Medical Service Association Medicare	$10,270.48
Rate for Payer: Humana Medicare	$10,270.48
Rate for Payer: Kaiser Permanente Medicare	$10,270.48
Rate for Payer: Ohana Health Plan Medicare	$10,270.48
Rate for Payer: UnitedHealthcare Medicare	$10,270.48

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC

Facility

$37,899.50

Service Code	MSDRG 857
Min. Negotiated Rate	$21,541.08
Max. Negotiated Rate	$37,899.50
Rate for Payer: AlohaCare Medicare	$21,541.08
Rate for Payer: Hawaii Medical Service Association Commercial	$37,899.50
Rate for Payer: Hawaii Medical Service Association Medicare	$21,541.08
Rate for Payer: Humana Medicare	$21,541.08
Rate for Payer: Kaiser Permanente Medicare	$21,541.08
Rate for Payer: Ohana Health Plan Medicare	$21,541.08
Rate for Payer: UnitedHealthcare Medicare	$21,541.08

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC

Facility

$45,264.90

Service Code	MSDRG 856
Min. Negotiated Rate	$37,899.50
Max. Negotiated Rate	$45,264.90
Rate for Payer: AlohaCare Medicare	$45,264.90
Rate for Payer: Hawaii Medical Service Association Commercial	$37,899.50
Rate for Payer: Hawaii Medical Service Association Medicare	$45,264.90
Rate for Payer: Humana Medicare	$45,264.90
Rate for Payer: Kaiser Permanente Medicare	$45,264.90
Rate for Payer: Ohana Health Plan Medicare	$45,264.90
Rate for Payer: UnitedHealthcare Medicare	$45,264.90

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$37,899.50

Service Code	MSDRG 858
Min. Negotiated Rate	$14,163.36
Max. Negotiated Rate	$37,899.50
Rate for Payer: AlohaCare Medicare	$14,163.36
Rate for Payer: Hawaii Medical Service Association Commercial	$37,899.50
Rate for Payer: Hawaii Medical Service Association Medicare	$14,163.36
Rate for Payer: Humana Medicare	$14,163.36
Rate for Payer: Kaiser Permanente Medicare	$14,163.36
Rate for Payer: Ohana Health Plan Medicare	$14,163.36
Rate for Payer: UnitedHealthcare Medicare	$14,163.36

POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES

Facility

$25,124.12

Service Code	MSDRG 769
Min. Negotiated Rate	$17,089.42
Max. Negotiated Rate	$25,124.12
Rate for Payer: AlohaCare Medicare	$17,089.42
Rate for Payer: Hawaii Medical Service Association Commercial	$25,124.12
Rate for Payer: Hawaii Medical Service Association Medicare	$17,089.42
Rate for Payer: Humana Medicare	$17,089.42
Rate for Payer: Kaiser Permanente Medicare	$17,089.42
Rate for Payer: Ohana Health Plan Medicare	$17,089.42
Rate for Payer: UnitedHealthcare Medicare	$17,089.42

POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES

Facility

$9,599.31

Service Code	MSDRG 776
Min. Negotiated Rate	$6,888.12
Max. Negotiated Rate	$9,599.31
Rate for Payer: AlohaCare Medicare	$6,888.12
Rate for Payer: Hawaii Medical Service Association Commercial	$9,599.31
Rate for Payer: Hawaii Medical Service Association Medicare	$6,888.12
Rate for Payer: Humana Medicare	$6,888.12
Rate for Payer: Kaiser Permanente Medicare	$6,888.12
Rate for Payer: Ohana Health Plan Medicare	$6,888.12
Rate for Payer: UnitedHealthcare Medicare	$6,888.12

Prealbumin

Facility

$248.00

Service Code	HCPCS 84134
Hospital Charge Code	84134
Hospital Revenue Code	301
Min. Negotiated Rate	$14.59
Max. Negotiated Rate	$240.56
Rate for Payer: AlohaCare Medicaid	$124.00
Rate for Payer: Cash Price	$161.20
Rate for Payer: Cash Price	$161.20
Rate for Payer: Hawaii Medical Service Association ABD	$20.16
Rate for Payer: Hawaii Medical Service Association Commercial	$18.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.17
Rate for Payer: Hawaii Western Management Group Commercial	$14.59
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Kaiser Permanente Commercial	$223.20
Rate for Payer: Kaiser Permanente Medicaid	$126.48
Rate for Payer: MDX Hawaii PPO	$240.56
Rate for Payer: UnitedHealthcare Medicaid	$20.16
Rate for Payer: University Health Alliance Commercial	$37.70

Prealbumin

Facility

$248.00

Service Code	HCPCS 84134
Hospital Charge Code	84134
Hospital Revenue Code	301
Min. Negotiated Rate	$210.80
Max. Negotiated Rate	$240.56
Rate for Payer: Cash Price	$161.20
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Kaiser Permanente Commercial	$223.20
Rate for Payer: MDX Hawaii PPO	$240.56

PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC

Facility

$20,407.42

Service Code	MSDRG 067
Min. Negotiated Rate	$14,910.39
Max. Negotiated Rate	$20,407.42
Rate for Payer: AlohaCare Medicare	$14,910.39
Rate for Payer: Hawaii Medical Service Association Commercial	$20,407.42
Rate for Payer: Hawaii Medical Service Association Medicare	$14,910.39
Rate for Payer: Humana Medicare	$14,910.39
Rate for Payer: Kaiser Permanente Medicare	$14,910.39
Rate for Payer: Ohana Health Plan Medicare	$14,910.39
Rate for Payer: UnitedHealthcare Medicare	$14,910.39

PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC

Facility

$20,407.42

Service Code	MSDRG 068
Min. Negotiated Rate	$8,954.81
Max. Negotiated Rate	$20,407.42
Rate for Payer: AlohaCare Medicare	$8,954.81
Rate for Payer: Hawaii Medical Service Association Commercial	$20,407.42
Rate for Payer: Hawaii Medical Service Association Medicare	$8,954.81
Rate for Payer: Humana Medicare	$8,954.81
Rate for Payer: Kaiser Permanente Medicare	$8,954.81
Rate for Payer: Ohana Health Plan Medicare	$8,954.81
Rate for Payer: UnitedHealthcare Medicare	$8,954.81

PREMATURITY WITH MAJOR PROBLEMS

Facility

$61,577.80

Service Code	MSDRG 791
Min. Negotiated Rate	$40,438.73
Max. Negotiated Rate	$61,577.80
Rate for Payer: AlohaCare Medicare	$40,438.73
Rate for Payer: Hawaii Medical Service Association Commercial	$61,577.80
Rate for Payer: Hawaii Medical Service Association Medicare	$40,438.73
Rate for Payer: Humana Medicare	$40,438.73
Rate for Payer: Kaiser Permanente Medicare	$40,438.73
Rate for Payer: Ohana Health Plan Medicare	$40,438.73
Rate for Payer: UnitedHealthcare Medicare	$40,438.73

PREMATURITY WITHOUT MAJOR PROBLEMS

Facility

$24,573.57

Service Code	MSDRG 792
Min. Negotiated Rate	$12,325.04
Max. Negotiated Rate	$24,573.57
Rate for Payer: AlohaCare Medicare	$24,573.57
Rate for Payer: Hawaii Medical Service Association Commercial	$12,325.04
Rate for Payer: Hawaii Medical Service Association Medicare	$24,573.57
Rate for Payer: Humana Medicare	$24,573.57
Rate for Payer: Kaiser Permanente Medicare	$24,573.57
Rate for Payer: Ohana Health Plan Medicare	$24,573.57
Rate for Payer: UnitedHealthcare Medicare	$24,573.57

Prneumococcal Conjugate Vaccine, PCV13

Facility

$562.00

Service Code	HCPCS 90670
Hospital Charge Code	PNEUM-13
Hospital Revenue Code	636
Min. Negotiated Rate	$257.99
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	$257.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$257.99
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

Prneumococcal Conjugate Vaccine, PCV13

Facility

$562.00

Service Code	HCPCS 90670
Hospital Charge Code	PNEUM-13
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

Prolonged service inpatient

Professional

Both

$172.00

Service Code	HCPCS 99357
Hospital Charge Code	99357
Min. Negotiated Rate	$91.98
Max. Negotiated Rate	$146.20
Rate for Payer: Cash Price	$111.80
Rate for Payer: Cash Price	$111.80
Rate for Payer: Hawaii Western Management Group Commercial	$91.98
Rate for Payer: Health Management Network Commercial	$146.20

Prolonged service inpatient

Professional

Both

$170.00

Service Code	HCPCS 99356
Hospital Charge Code	99356
Min. Negotiated Rate	$91.70
Max. Negotiated Rate	$144.50
Rate for Payer: Cash Price	$110.50
Rate for Payer: Cash Price	$110.50
Rate for Payer: Hawaii Western Management Group Commercial	$91.70
Rate for Payer: Health Management Network Commercial	$144.50

Prolong e&m/psyctx serv o/p

Professional

Both

$224.00

Service Code	HCPCS 99354
Hospital Charge Code	99354
Min. Negotiated Rate	$89.63
Max. Negotiated Rate	$190.40
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cash Price	$145.60
Rate for Payer: Hawaii Western Management Group Commercial	$89.63
Rate for Payer: Health Management Network Commercial	$190.40

Prolong e&m/psyctx serv o/p

Professional

Both

$164.00

Service Code	HCPCS 99355
Hospital Charge Code	99355
Min. Negotiated Rate	$64.63
Max. Negotiated Rate	$139.40
Rate for Payer: Cash Price	$106.60
Rate for Payer: Cash Price	$106.60
Rate for Payer: Hawaii Western Management Group Commercial	$64.63
Rate for Payer: Health Management Network Commercial	$139.40

PROSTATECTOMY WITH CC

Facility

$22,564.30

Service Code	MSDRG 666
Min. Negotiated Rate	$17,675.82
Max. Negotiated Rate	$22,564.30
Rate for Payer: AlohaCare Medicare	$17,675.82
Rate for Payer: Hawaii Medical Service Association Commercial	$22,564.30
Rate for Payer: Hawaii Medical Service Association Medicare	$17,675.82
Rate for Payer: Humana Medicare	$17,675.82
Rate for Payer: Kaiser Permanente Medicare	$17,675.82
Rate for Payer: Ohana Health Plan Medicare	$17,675.82
Rate for Payer: UnitedHealthcare Medicare	$17,675.82

PROSTATECTOMY WITH MCC

Facility

$31,196.38

Service Code	MSDRG 665
Min. Negotiated Rate	$22,564.30
Max. Negotiated Rate	$31,196.38
Rate for Payer: AlohaCare Medicare	$31,196.38
Rate for Payer: Hawaii Medical Service Association Commercial	$22,564.30
Rate for Payer: Hawaii Medical Service Association Medicare	$31,196.38
Rate for Payer: Humana Medicare	$31,196.38
Rate for Payer: Kaiser Permanente Medicare	$31,196.38
Rate for Payer: Ohana Health Plan Medicare	$31,196.38
Rate for Payer: UnitedHealthcare Medicare	$31,196.38

PROSTATECTOMY WITHOUT CC/MCC

Facility

$15,927.74

Service Code	MSDRG 667
Min. Negotiated Rate	$11,337.83
Max. Negotiated Rate	$15,927.74
Rate for Payer: AlohaCare Medicare	$11,337.83
Rate for Payer: Hawaii Medical Service Association Commercial	$15,927.74
Rate for Payer: Hawaii Medical Service Association Medicare	$11,337.83
Rate for Payer: Humana Medicare	$11,337.83
Rate for Payer: Kaiser Permanente Medicare	$11,337.83
Rate for Payer: Ohana Health Plan Medicare	$11,337.83
Rate for Payer: UnitedHealthcare Medicare	$11,337.83

Prosth Eval-Train Ea 15 Min Init Vst

Facility

$209.00

Service Code	HCPCS 97761 GN
Hospital Charge Code	ST97761
Hospital Revenue Code	440
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$202.73
Rate for Payer: AlohaCare Medicaid	$104.50
Rate for Payer: Cash Price	$135.85
Rate for Payer: Cash Price	$135.85
Rate for Payer: Hawaii Western Management Group Commercial	$198.55
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: Kaiser Permanente Commercial	$188.10
Rate for Payer: Kaiser Permanente Medicaid	$106.59
Rate for Payer: MDX Hawaii PPO	$202.73
Rate for Payer: UnitedHealthcare Medicaid	$17.70
Rate for Payer: University Health Alliance Commercial	$152.34

Prosth Eval-Train Ea 15 Min Init Vst

Facility

$209.00

Service Code	HCPCS 97761 GP
Hospital Charge Code	PT97761
Hospital Revenue Code	420
Min. Negotiated Rate	$177.65
Max. Negotiated Rate	$202.73
Rate for Payer: Cash Price	$135.85
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: Kaiser Permanente Commercial	$188.10
Rate for Payer: MDX Hawaii PPO	$202.73

Prosth Eval-Train Ea 15 Min Init Vst

Facility

$209.00

Service Code	HCPCS 97761 GP
Hospital Charge Code	PT97761
Hospital Revenue Code	420
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$202.73
Rate for Payer: AlohaCare Medicaid	$104.50
Rate for Payer: Cash Price	$135.85
Rate for Payer: Cash Price	$135.85
Rate for Payer: Hawaii Western Management Group Commercial	$198.55
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: Kaiser Permanente Commercial	$188.10
Rate for Payer: Kaiser Permanente Medicaid	$106.59
Rate for Payer: MDX Hawaii PPO	$202.73
Rate for Payer: UnitedHealthcare Medicaid	$17.70
Rate for Payer: University Health Alliance Commercial	$152.34

Know your out-of-pocket cost for care.

All Charges