Leahi Hospital

All Charges

Charge

Type

Setting

Price

PT Re-Eval Est Plan Care

Facility

$294.00

Service Code	HCPCS 97164 GP
Hospital Charge Code	PT97164
Hospital Revenue Code	424
Min. Negotiated Rate	$74.59
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$147.00
Rate for Payer: Cash Price	$191.10
Rate for Payer: Cash Price	$191.10
Rate for Payer: Hawaii Western Management Group Commercial	$279.30
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Kaiser Permanente Commercial	$264.60
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: UnitedHealthcare Medicaid	$74.59
Rate for Payer: University Health Alliance Commercial	$214.30

PT Re-Eval Est Plan Care

Facility

$294.00

Service Code	HCPCS 97164 GP
Hospital Charge Code	PT97164
Hospital Revenue Code	424
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$191.10
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Kaiser Permanente Commercial	$264.60
Rate for Payer: MDX Hawaii PPO	$285.18

PULMONARY EDEMA AND RESPIRATORY FAILURE

Facility

$45,602.65

Service Code	MSDRG 189
Min. Negotiated Rate	$12,611.14
Max. Negotiated Rate	$45,602.65
Rate for Payer: AlohaCare Medicare	$12,611.14
Rate for Payer: Hawaii Medical Service Association Commercial	$45,602.65
Rate for Payer: Hawaii Medical Service Association Medicare	$12,611.14
Rate for Payer: Humana Medicare	$12,611.14
Rate for Payer: Kaiser Permanente Medicare	$12,611.14
Rate for Payer: Ohana Health Plan Medicare	$12,611.14
Rate for Payer: UnitedHealthcare Medicare	$12,611.14

PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE

Facility

$30,954.81

Service Code	MSDRG 175
Min. Negotiated Rate	$13,973.14
Max. Negotiated Rate	$30,954.81
Rate for Payer: AlohaCare Medicare	$13,973.14
Rate for Payer: Hawaii Medical Service Association Commercial	$30,954.81
Rate for Payer: Hawaii Medical Service Association Medicare	$13,973.14
Rate for Payer: Humana Medicare	$13,973.14
Rate for Payer: Kaiser Permanente Medicare	$13,973.14
Rate for Payer: Ohana Health Plan Medicare	$13,973.14
Rate for Payer: UnitedHealthcare Medicare	$13,973.14

PULMONARY EMBOLISM WITHOUT MCC

Facility

$30,954.81

Service Code	MSDRG 176
Min. Negotiated Rate	$8,369.39
Max. Negotiated Rate	$30,954.81
Rate for Payer: AlohaCare Medicare	$8,369.39
Rate for Payer: Hawaii Medical Service Association Commercial	$30,954.81
Rate for Payer: Hawaii Medical Service Association Medicare	$8,369.39
Rate for Payer: Humana Medicare	$8,369.39
Rate for Payer: Kaiser Permanente Medicare	$8,369.39
Rate for Payer: Ohana Health Plan Medicare	$8,369.39
Rate for Payer: UnitedHealthcare Medicare	$8,369.39

RADIOTHERAPY

Facility

$27,138.92

Service Code	MSDRG 849
Min. Negotiated Rate	$17,373.57
Max. Negotiated Rate	$27,138.92
Rate for Payer: AlohaCare Medicare	$27,138.92
Rate for Payer: Hawaii Medical Service Association Commercial	$17,373.57
Rate for Payer: Hawaii Medical Service Association Medicare	$27,138.92
Rate for Payer: Humana Medicare	$27,138.92
Rate for Payer: Kaiser Permanente Medicare	$27,138.92
Rate for Payer: Ohana Health Plan Medicare	$27,138.92
Rate for Payer: UnitedHealthcare Medicare	$27,138.92

RECTAL RESECTION WITH CC

Facility

$71,224.51

Service Code	MSDRG 333
Min. Negotiated Rate	$23,519.05
Max. Negotiated Rate	$71,224.51
Rate for Payer: AlohaCare Medicare	$23,519.05
Rate for Payer: Hawaii Medical Service Association Commercial	$71,224.51
Rate for Payer: Hawaii Medical Service Association Medicare	$23,519.05
Rate for Payer: Humana Medicare	$23,519.05
Rate for Payer: Kaiser Permanente Medicare	$23,519.05
Rate for Payer: Ohana Health Plan Medicare	$23,519.05
Rate for Payer: UnitedHealthcare Medicare	$23,519.05

RECTAL RESECTION WITH MCC

Facility

$71,224.51

Service Code	MSDRG 332
Min. Negotiated Rate	$36,119.13
Max. Negotiated Rate	$71,224.51
Rate for Payer: AlohaCare Medicare	$36,119.13
Rate for Payer: Hawaii Medical Service Association Commercial	$71,224.51
Rate for Payer: Hawaii Medical Service Association Medicare	$36,119.13
Rate for Payer: Humana Medicare	$36,119.13
Rate for Payer: Kaiser Permanente Medicare	$36,119.13
Rate for Payer: Ohana Health Plan Medicare	$36,119.13
Rate for Payer: UnitedHealthcare Medicare	$36,119.13

RECTAL RESECTION WITHOUT CC/MCC

Facility

$34,083.48

Service Code	MSDRG 334
Min. Negotiated Rate	$16,577.91
Max. Negotiated Rate	$34,083.48
Rate for Payer: AlohaCare Medicare	$16,577.91
Rate for Payer: Hawaii Medical Service Association Commercial	$34,083.48
Rate for Payer: Hawaii Medical Service Association Medicare	$16,577.91
Rate for Payer: Humana Medicare	$16,577.91
Rate for Payer: Kaiser Permanente Medicare	$16,577.91
Rate for Payer: Ohana Health Plan Medicare	$16,577.91
Rate for Payer: UnitedHealthcare Medicare	$16,577.91

RED BLOOD CELL DISORDERS WITH MCC

Facility

$31,049.62

Service Code	MSDRG 811
Min. Negotiated Rate	$14,275.71
Max. Negotiated Rate	$31,049.62
Rate for Payer: AlohaCare Medicare	$14,275.71
Rate for Payer: Hawaii Medical Service Association Commercial	$31,049.62
Rate for Payer: Hawaii Medical Service Association Medicare	$14,275.71
Rate for Payer: Humana Medicare	$14,275.71
Rate for Payer: Kaiser Permanente Medicare	$14,275.71
Rate for Payer: Ohana Health Plan Medicare	$14,275.71
Rate for Payer: UnitedHealthcare Medicare	$14,275.71

RED BLOOD CELL DISORDERS WITHOUT MCC

Facility

$16,638.80

Service Code	MSDRG 812
Min. Negotiated Rate	$9,485.02
Max. Negotiated Rate	$16,638.80
Rate for Payer: AlohaCare Medicare	$9,485.02
Rate for Payer: Hawaii Medical Service Association Commercial	$16,638.80
Rate for Payer: Hawaii Medical Service Association Medicare	$9,485.02
Rate for Payer: Humana Medicare	$9,485.02
Rate for Payer: Kaiser Permanente Medicare	$9,485.02
Rate for Payer: Ohana Health Plan Medicare	$9,485.02
Rate for Payer: UnitedHealthcare Medicare	$9,485.02

REHABILITATION WITH CC/MCC

Facility

$15,697.83

Service Code	MSDRG 945
Min. Negotiated Rate	$9,765.22
Max. Negotiated Rate	$15,697.83
Rate for Payer: AlohaCare Medicare	$15,697.83
Rate for Payer: Hawaii Medical Service Association Commercial	$9,765.22
Rate for Payer: Hawaii Medical Service Association Medicare	$15,697.83
Rate for Payer: Humana Medicare	$15,697.83
Rate for Payer: Kaiser Permanente Medicare	$15,697.83
Rate for Payer: Ohana Health Plan Medicare	$15,697.83
Rate for Payer: UnitedHealthcare Medicare	$15,697.83

REHABILITATION WITHOUT CC/MCC

Facility

$11,737.95

Service Code	MSDRG 946
Min. Negotiated Rate	$9,765.22
Max. Negotiated Rate	$11,737.95
Rate for Payer: AlohaCare Medicare	$11,737.95
Rate for Payer: Hawaii Medical Service Association Commercial	$9,765.22
Rate for Payer: Hawaii Medical Service Association Medicare	$11,737.95
Rate for Payer: Humana Medicare	$11,737.95
Rate for Payer: Kaiser Permanente Medicare	$11,737.95
Rate for Payer: Ohana Health Plan Medicare	$11,737.95
Rate for Payer: UnitedHealthcare Medicare	$11,737.95

RENAL FAILURE WITH CC

Facility

$30,006.73

Service Code	MSDRG 683
Min. Negotiated Rate	$9,067.14
Max. Negotiated Rate	$30,006.73
Rate for Payer: AlohaCare Medicare	$9,067.14
Rate for Payer: Hawaii Medical Service Association Commercial	$30,006.73
Rate for Payer: Hawaii Medical Service Association Medicare	$9,067.14
Rate for Payer: Humana Medicare	$9,067.14
Rate for Payer: Kaiser Permanente Medicare	$9,067.14
Rate for Payer: Ohana Health Plan Medicare	$9,067.14
Rate for Payer: UnitedHealthcare Medicare	$9,067.14

RENAL FAILURE WITH MCC

Facility

$30,006.73

Service Code	MSDRG 682
Min. Negotiated Rate	$15,031.60
Max. Negotiated Rate	$30,006.73
Rate for Payer: AlohaCare Medicare	$15,031.60
Rate for Payer: Hawaii Medical Service Association Commercial	$30,006.73
Rate for Payer: Hawaii Medical Service Association Medicare	$15,031.60
Rate for Payer: Humana Medicare	$15,031.60
Rate for Payer: Kaiser Permanente Medicare	$15,031.60
Rate for Payer: Ohana Health Plan Medicare	$15,031.60
Rate for Payer: UnitedHealthcare Medicare	$15,031.60

RENAL FAILURE WITHOUT CC/MCC

Facility

$30,006.73

Service Code	MSDRG 684
Min. Negotiated Rate	$6,351.99
Max. Negotiated Rate	$30,006.73
Rate for Payer: AlohaCare Medicare	$6,351.99
Rate for Payer: Hawaii Medical Service Association Commercial	$30,006.73
Rate for Payer: Hawaii Medical Service Association Medicare	$6,351.99
Rate for Payer: Humana Medicare	$6,351.99
Rate for Payer: Kaiser Permanente Medicare	$6,351.99
Rate for Payer: Ohana Health Plan Medicare	$6,351.99
Rate for Payer: UnitedHealthcare Medicare	$6,351.99

Renal Function Panel

Facility

$164.00

Service Code	HCPCS 80069
Hospital Charge Code	80069
Hospital Revenue Code	301
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$159.08
Rate for Payer: AlohaCare Medicaid	$82.00
Rate for Payer: Cash Price	$106.60
Rate for Payer: Cash Price	$106.60
Rate for Payer: Hawaii Medical Service Association ABD	$12.00
Rate for Payer: Hawaii Medical Service Association Commercial	$10.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.60
Rate for Payer: Hawaii Western Management Group Commercial	$8.68
Rate for Payer: Health Management Network Commercial	$139.40
Rate for Payer: Kaiser Permanente Commercial	$147.60
Rate for Payer: Kaiser Permanente Medicaid	$83.64
Rate for Payer: MDX Hawaii PPO	$159.08
Rate for Payer: UnitedHealthcare Medicaid	$12.00
Rate for Payer: University Health Alliance Commercial	$22.44

Renal Function Panel

Facility

$164.00

Service Code	HCPCS 80069
Hospital Charge Code	80069
Hospital Revenue Code	301
Min. Negotiated Rate	$139.40
Max. Negotiated Rate	$159.08
Rate for Payer: Cash Price	$106.60
Rate for Payer: Health Management Network Commercial	$139.40
Rate for Payer: Kaiser Permanente Commercial	$147.60
Rate for Payer: MDX Hawaii PPO	$159.08

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC

Facility

$42,142.16

Service Code	MSDRG 178
Min. Negotiated Rate	$10,054.66
Max. Negotiated Rate	$42,142.16
Rate for Payer: AlohaCare Medicare	$10,054.66
Rate for Payer: Hawaii Medical Service Association Commercial	$42,142.16
Rate for Payer: Hawaii Medical Service Association Medicare	$10,054.66
Rate for Payer: Humana Medicare	$10,054.66
Rate for Payer: Kaiser Permanente Medicare	$10,054.66
Rate for Payer: Ohana Health Plan Medicare	$10,054.66
Rate for Payer: UnitedHealthcare Medicare	$10,054.66

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC

Facility

$42,142.16

Service Code	MSDRG 177
Min. Negotiated Rate	$15,836.80
Max. Negotiated Rate	$42,142.16
Rate for Payer: AlohaCare Medicare	$15,836.80
Rate for Payer: Hawaii Medical Service Association Commercial	$42,142.16
Rate for Payer: Hawaii Medical Service Association Medicare	$15,836.80
Rate for Payer: Humana Medicare	$15,836.80
Rate for Payer: Kaiser Permanente Medicare	$15,836.80
Rate for Payer: Ohana Health Plan Medicare	$15,836.80
Rate for Payer: UnitedHealthcare Medicare	$15,836.80

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility

$33,277.61

Service Code	MSDRG 179
Min. Negotiated Rate	$7,876.62
Max. Negotiated Rate	$33,277.61
Rate for Payer: AlohaCare Medicare	$7,876.62
Rate for Payer: Hawaii Medical Service Association Commercial	$33,277.61
Rate for Payer: Hawaii Medical Service Association Medicare	$7,876.62
Rate for Payer: Humana Medicare	$7,876.62
Rate for Payer: Kaiser Permanente Medicare	$7,876.62
Rate for Payer: Ohana Health Plan Medicare	$7,876.62
Rate for Payer: UnitedHealthcare Medicare	$7,876.62

RESPIRATORY NEOPLASMS WITH CC

Facility

$35,932.23

Service Code	MSDRG 181
Min. Negotiated Rate	$10,990.92
Max. Negotiated Rate	$35,932.23
Rate for Payer: AlohaCare Medicare	$10,990.92
Rate for Payer: Hawaii Medical Service Association Commercial	$35,932.23
Rate for Payer: Hawaii Medical Service Association Medicare	$10,990.92
Rate for Payer: Humana Medicare	$10,990.92
Rate for Payer: Kaiser Permanente Medicare	$10,990.92
Rate for Payer: Ohana Health Plan Medicare	$10,990.92
Rate for Payer: UnitedHealthcare Medicare	$10,990.92

RESPIRATORY NEOPLASMS WITH MCC

Facility

$35,932.23

Service Code	MSDRG 180
Min. Negotiated Rate	$17,840.39
Max. Negotiated Rate	$35,932.23
Rate for Payer: AlohaCare Medicare	$17,840.39
Rate for Payer: Hawaii Medical Service Association Commercial	$35,932.23
Rate for Payer: Hawaii Medical Service Association Medicare	$17,840.39
Rate for Payer: Humana Medicare	$17,840.39
Rate for Payer: Kaiser Permanente Medicare	$17,840.39
Rate for Payer: Ohana Health Plan Medicare	$17,840.39
Rate for Payer: UnitedHealthcare Medicare	$17,840.39

RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility

$35,932.23

Service Code	MSDRG 182
Min. Negotiated Rate	$7,864.79
Max. Negotiated Rate	$35,932.23
Rate for Payer: AlohaCare Medicare	$7,864.79
Rate for Payer: Hawaii Medical Service Association Commercial	$35,932.23
Rate for Payer: Hawaii Medical Service Association Medicare	$7,864.79
Rate for Payer: Humana Medicare	$7,864.79
Rate for Payer: Kaiser Permanente Medicare	$7,864.79
Rate for Payer: Ohana Health Plan Medicare	$7,864.79
Rate for Payer: UnitedHealthcare Medicare	$7,864.79

RESPIRATORY SIGNS AND SYMPTOMS

Facility

$13,486.44

Service Code	MSDRG 204
Min. Negotiated Rate	$8,393.03
Max. Negotiated Rate	$13,486.44
Rate for Payer: AlohaCare Medicare	$8,393.03
Rate for Payer: Hawaii Medical Service Association Commercial	$13,486.44
Rate for Payer: Hawaii Medical Service Association Medicare	$8,393.03
Rate for Payer: Humana Medicare	$8,393.03
Rate for Payer: Kaiser Permanente Medicare	$8,393.03
Rate for Payer: Ohana Health Plan Medicare	$8,393.03
Rate for Payer: UnitedHealthcare Medicare	$8,393.03

Know your out-of-pocket cost for care.

All Charges