Leahi Hospital

All Charges

Charge

Type

Setting

Price

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	$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

$150.00

Service Code	HCPCS 97761 GO
Hospital Charge Code	OT97761
Hospital Revenue Code	430
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$75.00
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Hawaii Western Management Group Commercial	$142.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: UnitedHealthcare Medicaid	$17.70
Rate for Payer: University Health Alliance Commercial	$109.33

Prosth Eval-Train Ea 15 Min Init Vst

Facility

$150.00

Service Code	HCPCS 97761 GO
Hospital Charge Code	OT97761
Hospital Revenue Code	430
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: MDX Hawaii PPO	$145.50

Prosth Eval-Train Ea 15 Min Sbsq Vst

Facility

$217.00

Service Code	HCPCS 97763 GP
Hospital Charge Code	PT97763
Hospital Revenue Code	420
Min. Negotiated Rate	$57.47
Max. Negotiated Rate	$210.49
Rate for Payer: AlohaCare Medicaid	$108.50
Rate for Payer: Cash Price	$141.05
Rate for Payer: Cash Price	$141.05
Rate for Payer: Hawaii Western Management Group Commercial	$206.15
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: Kaiser Permanente Commercial	$195.30
Rate for Payer: Kaiser Permanente Medicaid	$110.67
Rate for Payer: MDX Hawaii PPO	$210.49
Rate for Payer: UnitedHealthcare Medicaid	$57.47
Rate for Payer: University Health Alliance Commercial	$158.17

Prosth Eval-Train Ea 15 Min Sbsq Vst

Facility

$217.00

Service Code	HCPCS 97763 GO
Hospital Charge Code	OT97763
Hospital Revenue Code	430
Min. Negotiated Rate	$57.47
Max. Negotiated Rate	$210.49
Rate for Payer: AlohaCare Medicaid	$108.50
Rate for Payer: Cash Price	$141.05
Rate for Payer: Cash Price	$141.05
Rate for Payer: Hawaii Western Management Group Commercial	$206.15
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: Kaiser Permanente Commercial	$195.30
Rate for Payer: Kaiser Permanente Medicaid	$110.67
Rate for Payer: MDX Hawaii PPO	$210.49
Rate for Payer: UnitedHealthcare Medicaid	$57.47
Rate for Payer: University Health Alliance Commercial	$158.17

Prosth Eval-Train Ea 15 Min Sbsq Vst

Facility

$217.00

Service Code	HCPCS 97763 GN
Hospital Charge Code	ST97763
Hospital Revenue Code	440
Min. Negotiated Rate	$57.47
Max. Negotiated Rate	$210.49
Rate for Payer: AlohaCare Medicaid	$108.50
Rate for Payer: Cash Price	$141.05
Rate for Payer: Cash Price	$141.05
Rate for Payer: Hawaii Western Management Group Commercial	$206.15
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: Kaiser Permanente Commercial	$195.30
Rate for Payer: Kaiser Permanente Medicaid	$110.67
Rate for Payer: MDX Hawaii PPO	$210.49
Rate for Payer: UnitedHealthcare Medicaid	$57.47
Rate for Payer: University Health Alliance Commercial	$158.17

Prosth Eval-Train Ea 15 Min Sbsq Vst

Facility

$217.00

Service Code	HCPCS 97763 GO
Hospital Charge Code	OT97763
Hospital Revenue Code	430
Min. Negotiated Rate	$184.45
Max. Negotiated Rate	$210.49
Rate for Payer: Cash Price	$141.05
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: Kaiser Permanente Commercial	$195.30
Rate for Payer: MDX Hawaii PPO	$210.49

Prosth Eval-Train Ea 15 Min Sbsq Vst

Facility

$217.00

Service Code	HCPCS 97763 GP
Hospital Charge Code	PT97763
Hospital Revenue Code	420
Min. Negotiated Rate	$184.45
Max. Negotiated Rate	$210.49
Rate for Payer: Cash Price	$141.05
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: Kaiser Permanente Commercial	$195.30
Rate for Payer: MDX Hawaii PPO	$210.49

Prosth Eval-Train Ea 15 Min Sbsq Vst

Facility

$217.00

Service Code	HCPCS 97763 GN
Hospital Charge Code	ST97763
Hospital Revenue Code	440
Min. Negotiated Rate	$184.45
Max. Negotiated Rate	$210.49
Rate for Payer: Cash Price	$141.05
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: Kaiser Permanente Commercial	$195.30
Rate for Payer: MDX Hawaii PPO	$210.49

Protein Urine Random

Facility

$78.00

Service Code	HCPCS 84156
Hospital Charge Code	84156
Hospital Revenue Code	301
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$50.70
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: MDX Hawaii PPO	$75.66

Protein Urine Random

Facility

$78.00

Service Code	HCPCS 84156
Hospital Charge Code	84156
Hospital Revenue Code	301
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$75.66
Rate for Payer: AlohaCare Medicaid	$39.00
Rate for Payer: Cash Price	$50.70
Rate for Payer: Cash Price	$50.70
Rate for Payer: Hawaii Medical Service Association ABD	$3.69
Rate for Payer: Hawaii Medical Service Association Commercial	$4.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.06
Rate for Payer: Hawaii Western Management Group Commercial	$3.67
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: UnitedHealthcare Medicaid	$3.69
Rate for Payer: University Health Alliance Commercial	$9.47

Prothrombin time (PT)

Facility

$70.00

Service Code	HCPCS 85610
Hospital Charge Code	85610
Hospital Revenue Code	305
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$45.50
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: MDX Hawaii PPO	$67.90

Prothrombin time (PT)

Facility

$70.00

Service Code	HCPCS 85610
Hospital Charge Code	85610
Hospital Revenue Code	305
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$67.90
Rate for Payer: AlohaCare Medicaid	$35.00
Rate for Payer: Cash Price	$45.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Hawaii Medical Service Association ABD	$5.43
Rate for Payer: Hawaii Medical Service Association Commercial	$5.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.70
Rate for Payer: Hawaii Western Management Group Commercial	$4.29
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: Kaiser Permanente Medicaid	$35.70
Rate for Payer: MDX Hawaii PPO	$67.90
Rate for Payer: UnitedHealthcare Medicaid	$5.43
Rate for Payer: University Health Alliance Commercial	$10.16

Psych diag eval w/med srvcs

Professional

Both

$324.00

Service Code	HCPCS 90792
Hospital Charge Code	90792
Min. Negotiated Rate	$158.95
Max. Negotiated Rate	$275.40
Rate for Payer: AlohaCare Medicaid	$170.34
Rate for Payer: AlohaCare Medicare	$158.95
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: Hawaii Medical Service Association ABD	$170.34
Rate for Payer: Hawaii Medical Service Association Medicare	$158.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$170.34
Rate for Payer: Health Management Network Commercial	$275.40
Rate for Payer: Kaiser Permanente Commercial	$190.74
Rate for Payer: Kaiser Permanente Medicaid	$190.74
Rate for Payer: Kaiser Permanente Medicare	$190.74
Rate for Payer: Ohana Health Plan Medicare	$158.95
Rate for Payer: UnitedHealthcare Medicaid	$170.34
Rate for Payer: UnitedHealthcare Medicare	$158.95
Rate for Payer: University Health Alliance Commercial	$205.90

PSYCHOSES

Facility

$15,761.83

Service Code	MSDRG 885
Min. Negotiated Rate	$14,201.79
Max. Negotiated Rate	$15,761.83
Rate for Payer: AlohaCare Medicare	$14,201.79
Rate for Payer: Hawaii Medical Service Association Commercial	$15,761.83
Rate for Payer: Hawaii Medical Service Association Medicare	$14,201.79
Rate for Payer: Humana Medicare	$14,201.79
Rate for Payer: Kaiser Permanente Medicare	$14,201.79
Rate for Payer: Ohana Health Plan Medicare	$14,201.79
Rate for Payer: UnitedHealthcare Medicare	$14,201.79

Psytx w pt w e/m 30 min

Professional

Both

$116.00

Service Code	HCPCS 90833
Hospital Charge Code	90833
Min. Negotiated Rate	$64.28
Max. Negotiated Rate	$98.60
Rate for Payer: AlohaCare Medicaid	$64.28
Rate for Payer: AlohaCare Medicare	$65.68
Rate for Payer: Cash Price	$75.40
Rate for Payer: Cash Price	$75.40
Rate for Payer: Hawaii Medical Service Association ABD	$64.28
Rate for Payer: Hawaii Medical Service Association Medicare	$65.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$64.28
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: Kaiser Permanente Commercial	$78.82
Rate for Payer: Kaiser Permanente Medicaid	$78.82
Rate for Payer: Kaiser Permanente Medicare	$78.82
Rate for Payer: Ohana Health Plan Medicare	$65.68
Rate for Payer: UnitedHealthcare Medicaid	$64.28
Rate for Payer: UnitedHealthcare Medicare	$65.68

Psytx w pt w e/m 45 min

Professional

Both

$148.00

Service Code	HCPCS 90836
Hospital Charge Code	90836
Min. Negotiated Rate	$81.51
Max. Negotiated Rate	$125.80
Rate for Payer: AlohaCare Medicaid	$81.51
Rate for Payer: AlohaCare Medicare	$83.14
Rate for Payer: Cash Price	$96.20
Rate for Payer: Cash Price	$96.20
Rate for Payer: Hawaii Medical Service Association ABD	$81.51
Rate for Payer: Hawaii Medical Service Association Medicare	$83.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$81.51
Rate for Payer: Health Management Network Commercial	$125.80
Rate for Payer: Kaiser Permanente Commercial	$99.77
Rate for Payer: Kaiser Permanente Medicaid	$99.77
Rate for Payer: Kaiser Permanente Medicare	$99.77
Rate for Payer: Ohana Health Plan Medicare	$83.14
Rate for Payer: UnitedHealthcare Medicaid	$81.51
Rate for Payer: UnitedHealthcare Medicare	$83.14
Rate for Payer: University Health Alliance Commercial	$94.85

PT Eval High Complex 45 Min

Facility

$527.00

Service Code	HCPCS 97163 GP
Hospital Charge Code	PT97163
Hospital Revenue Code	424
Min. Negotiated Rate	$106.70
Max. Negotiated Rate	$511.19
Rate for Payer: AlohaCare Medicaid	$263.50
Rate for Payer: Cash Price	$342.55
Rate for Payer: Cash Price	$342.55
Rate for Payer: Hawaii Western Management Group Commercial	$500.65
Rate for Payer: Health Management Network Commercial	$447.95
Rate for Payer: Kaiser Permanente Commercial	$474.30
Rate for Payer: Kaiser Permanente Medicaid	$268.77
Rate for Payer: MDX Hawaii PPO	$511.19
Rate for Payer: UnitedHealthcare Medicaid	$106.70
Rate for Payer: University Health Alliance Commercial	$384.13

PT Eval High Complex 45 Min

Facility

$527.00

Service Code	HCPCS 97163 GP
Hospital Charge Code	PT97163
Hospital Revenue Code	424
Min. Negotiated Rate	$447.95
Max. Negotiated Rate	$511.19
Rate for Payer: Cash Price	$342.55
Rate for Payer: Health Management Network Commercial	$447.95
Rate for Payer: Kaiser Permanente Commercial	$474.30
Rate for Payer: MDX Hawaii PPO	$511.19

PT Eval Low Complex 20 Min

Facility

$585.00

Service Code	HCPCS 97161 GP
Hospital Charge Code	PT97161
Hospital Revenue Code	424
Min. Negotiated Rate	$497.25
Max. Negotiated Rate	$567.45
Rate for Payer: Cash Price	$380.25
Rate for Payer: Health Management Network Commercial	$497.25
Rate for Payer: Kaiser Permanente Commercial	$526.50
Rate for Payer: MDX Hawaii PPO	$567.45

PT Eval Low Complex 20 Min

Facility

$585.00

Service Code	HCPCS 97161 GP
Hospital Charge Code	PT97161
Hospital Revenue Code	424
Min. Negotiated Rate	$106.70
Max. Negotiated Rate	$567.45
Rate for Payer: AlohaCare Medicaid	$292.50
Rate for Payer: Cash Price	$380.25
Rate for Payer: Cash Price	$380.25
Rate for Payer: Hawaii Western Management Group Commercial	$555.75
Rate for Payer: Health Management Network Commercial	$497.25
Rate for Payer: Kaiser Permanente Commercial	$526.50
Rate for Payer: Kaiser Permanente Medicaid	$298.35
Rate for Payer: MDX Hawaii PPO	$567.45
Rate for Payer: UnitedHealthcare Medicaid	$106.70
Rate for Payer: University Health Alliance Commercial	$426.41

PT Eval Mod Complex 30 Min

Facility

$479.00

Service Code	HCPCS 97162 GP
Hospital Charge Code	PT97162
Hospital Revenue Code	424
Min. Negotiated Rate	$106.70
Max. Negotiated Rate	$464.63
Rate for Payer: AlohaCare Medicaid	$239.50
Rate for Payer: Cash Price	$311.35
Rate for Payer: Cash Price	$311.35
Rate for Payer: Hawaii Western Management Group Commercial	$455.05
Rate for Payer: Health Management Network Commercial	$407.15
Rate for Payer: Kaiser Permanente Commercial	$431.10
Rate for Payer: Kaiser Permanente Medicaid	$244.29
Rate for Payer: MDX Hawaii PPO	$464.63
Rate for Payer: UnitedHealthcare Medicaid	$106.70
Rate for Payer: University Health Alliance Commercial	$349.14

PT Eval Mod Complex 30 Min

Facility

$479.00

Service Code	HCPCS 97162 GP
Hospital Charge Code	PT97162
Hospital Revenue Code	424
Min. Negotiated Rate	$407.15
Max. Negotiated Rate	$464.63
Rate for Payer: Cash Price	$311.35
Rate for Payer: Health Management Network Commercial	$407.15
Rate for Payer: Kaiser Permanente Commercial	$431.10
Rate for Payer: MDX Hawaii PPO	$464.63

PTH Intact

Facility

$702.00

Service Code	HCPCS 83970
Hospital Charge Code	83970
Hospital Revenue Code	301
Min. Negotiated Rate	$596.70
Max. Negotiated Rate	$680.94
Rate for Payer: Cash Price	$456.30
Rate for Payer: Health Management Network Commercial	$596.70
Rate for Payer: Kaiser Permanente Commercial	$631.80
Rate for Payer: MDX Hawaii PPO	$680.94

PTH Intact

Facility

$702.00

Service Code	HCPCS 83970
Hospital Charge Code	83970
Hospital Revenue Code	301
Min. Negotiated Rate	$41.28
Max. Negotiated Rate	$680.94
Rate for Payer: AlohaCare Medicaid	$351.00
Rate for Payer: Cash Price	$456.30
Rate for Payer: Cash Price	$456.30
Rate for Payer: Hawaii Medical Service Association ABD	$57.04
Rate for Payer: Hawaii Medical Service Association Commercial	$51.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.89
Rate for Payer: Hawaii Western Management Group Commercial	$41.28
Rate for Payer: Health Management Network Commercial	$596.70
Rate for Payer: Kaiser Permanente Commercial	$631.80
Rate for Payer: Kaiser Permanente Medicaid	$358.02
Rate for Payer: MDX Hawaii PPO	$680.94
Rate for Payer: UnitedHealthcare Medicaid	$57.04
Rate for Payer: University Health Alliance Commercial	$106.69

Know your out-of-pocket cost for care.

All Charges