Leahi Hospital

All Charges

Charge

Type

Setting

Price

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS

Facility

$70,205.32

Service Code	MSDRG 208
Min. Negotiated Rate	$27,525.24
Max. Negotiated Rate	$70,205.32
Rate for Payer: AlohaCare Medicare	$27,525.24
Rate for Payer: Hawaii Medical Service Association Commercial	$70,205.32
Rate for Payer: Hawaii Medical Service Association Medicare	$27,525.24
Rate for Payer: Humana Medicare	$27,525.24
Rate for Payer: Kaiser Permanente Medicare	$27,525.24
Rate for Payer: Ohana Health Plan Medicare	$27,525.24
Rate for Payer: UnitedHealthcare Medicare	$27,525.24

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS

Facility

$185,231.13

Service Code	MSDRG 207
Min. Negotiated Rate	$63,852.11
Max. Negotiated Rate	$185,231.13
Rate for Payer: AlohaCare Medicare	$63,852.11
Rate for Payer: Hawaii Medical Service Association Commercial	$185,231.13
Rate for Payer: Hawaii Medical Service Association Medicare	$63,852.11
Rate for Payer: Humana Medicare	$63,852.11
Rate for Payer: Kaiser Permanente Medicare	$63,852.11
Rate for Payer: Ohana Health Plan Medicare	$63,852.11
Rate for Payer: UnitedHealthcare Medicare	$63,852.11

Retculucyte count panel

Facility

$73.00

Service Code	HCPCS 85044
Hospital Charge Code	85044
Hospital Revenue Code	305
Min. Negotiated Rate	$62.05
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$47.45
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Kaiser Permanente Commercial	$65.70
Rate for Payer: MDX Hawaii PPO	$70.81

Retculucyte count panel

Facility

$73.00

Service Code	HCPCS 85044
Hospital Charge Code	85044
Hospital Revenue Code	305
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$70.81
Rate for Payer: AlohaCare Medicaid	$36.50
Rate for Payer: Cash Price	$47.45
Rate for Payer: Cash Price	$47.45
Rate for Payer: Hawaii Medical Service Association ABD	$5.94
Rate for Payer: Hawaii Medical Service Association Commercial	$5.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.24
Rate for Payer: Hawaii Western Management Group Commercial	$4.31
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Kaiser Permanente Commercial	$65.70
Rate for Payer: Kaiser Permanente Medicaid	$37.23
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: UnitedHealthcare Medicaid	$5.94
Rate for Payer: University Health Alliance Commercial	$11.12

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC

Facility

$15,975.15

Service Code	MSDRG 815
Min. Negotiated Rate	$10,429.16
Max. Negotiated Rate	$15,975.15
Rate for Payer: AlohaCare Medicare	$10,429.16
Rate for Payer: Hawaii Medical Service Association Commercial	$15,975.15
Rate for Payer: Hawaii Medical Service Association Medicare	$10,429.16
Rate for Payer: Humana Medicare	$10,429.16
Rate for Payer: Kaiser Permanente Medicare	$10,429.16
Rate for Payer: Ohana Health Plan Medicare	$10,429.16
Rate for Payer: UnitedHealthcare Medicare	$10,429.16

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC

Facility

$21,395.22

Service Code	MSDRG 814
Min. Negotiated Rate	$15,975.15
Max. Negotiated Rate	$21,395.22
Rate for Payer: AlohaCare Medicare	$21,395.22
Rate for Payer: Hawaii Medical Service Association Commercial	$15,975.15
Rate for Payer: Hawaii Medical Service Association Medicare	$21,395.22
Rate for Payer: Humana Medicare	$21,395.22
Rate for Payer: Kaiser Permanente Medicare	$21,395.22
Rate for Payer: Ohana Health Plan Medicare	$21,395.22
Rate for Payer: UnitedHealthcare Medicare	$21,395.22

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC

Facility

$11,685.09

Service Code	MSDRG 816
Min. Negotiated Rate	$6,664.42
Max. Negotiated Rate	$11,685.09
Rate for Payer: AlohaCare Medicare	$6,664.42
Rate for Payer: Hawaii Medical Service Association Commercial	$11,685.09
Rate for Payer: Hawaii Medical Service Association Medicare	$6,664.42
Rate for Payer: Humana Medicare	$6,664.42
Rate for Payer: Kaiser Permanente Medicare	$6,664.42
Rate for Payer: Ohana Health Plan Medicare	$6,664.42
Rate for Payer: UnitedHealthcare Medicare	$6,664.42

REVISION OF HIP OR KNEE REPLACEMENT WITH CC

Facility

$56,576.67

Service Code	MSDRG 467
Min. Negotiated Rate	$35,191.73
Max. Negotiated Rate	$56,576.67
Rate for Payer: AlohaCare Medicare	$35,191.73
Rate for Payer: Hawaii Medical Service Association Commercial	$56,576.67
Rate for Payer: Hawaii Medical Service Association Medicare	$35,191.73
Rate for Payer: Humana Medicare	$35,191.73
Rate for Payer: Kaiser Permanente Medicare	$35,191.73
Rate for Payer: Ohana Health Plan Medicare	$35,191.73
Rate for Payer: UnitedHealthcare Medicare	$35,191.73

REVISION OF HIP OR KNEE REPLACEMENT WITH MCC

Facility

$56,576.67

Service Code	MSDRG 466
Min. Negotiated Rate	$51,736.90
Max. Negotiated Rate	$56,576.67
Rate for Payer: AlohaCare Medicare	$51,736.90
Rate for Payer: Hawaii Medical Service Association Commercial	$56,576.67
Rate for Payer: Hawaii Medical Service Association Medicare	$51,736.90
Rate for Payer: Humana Medicare	$51,736.90
Rate for Payer: Kaiser Permanente Medicare	$51,736.90
Rate for Payer: Ohana Health Plan Medicare	$51,736.90
Rate for Payer: UnitedHealthcare Medicare	$51,736.90

REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC

Facility

$56,576.67

Service Code	MSDRG 468
Min. Negotiated Rate	$27,518.35
Max. Negotiated Rate	$56,576.67
Rate for Payer: AlohaCare Medicare	$27,518.35
Rate for Payer: Hawaii Medical Service Association Commercial	$56,576.67
Rate for Payer: Hawaii Medical Service Association Medicare	$27,518.35
Rate for Payer: Humana Medicare	$27,518.35
Rate for Payer: Kaiser Permanente Medicare	$27,518.35
Rate for Payer: Ohana Health Plan Medicare	$27,518.35
Rate for Payer: UnitedHealthcare Medicare	$27,518.35

Rom trunk

Facility

$152.00

Service Code	HCPCS 95851 GO
Hospital Charge Code	OT95851
Hospital Revenue Code	430
Min. Negotiated Rate	$7.89
Max. Negotiated Rate	$147.44
Rate for Payer: AlohaCare Medicaid	$76.00
Rate for Payer: Cash Price	$98.80
Rate for Payer: Cash Price	$98.80
Rate for Payer: Hawaii Western Management Group Commercial	$144.40
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: Kaiser Permanente Medicaid	$77.52
Rate for Payer: MDX Hawaii PPO	$147.44
Rate for Payer: UnitedHealthcare Medicaid	$7.89
Rate for Payer: University Health Alliance Commercial	$110.79

Rom trunk

Facility

$152.00

Service Code	HCPCS 95851 GO
Hospital Charge Code	OT95851
Hospital Revenue Code	430
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$98.80
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: MDX Hawaii PPO	$147.44

Room Chg - Private ICF

Facility

$519.00

Hospital Charge Code	R&B
Hospital Revenue Code	111
Min. Negotiated Rate	$441.15
Max. Negotiated Rate	$7,250.00
Rate for Payer: AlohaCare Medicaid	$480.19
Rate for Payer: Cash Price	$337.35
Rate for Payer: Cash Price	$337.35
Rate for Payer: Hawaii Medical Service Association ABD	$774.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$774.17
Rate for Payer: Hawaii Western Management Group Commercial	$7,250.00
Rate for Payer: Health Management Network Commercial	$441.15
Rate for Payer: Kaiser Permanente Commercial	$467.10
Rate for Payer: Kaiser Permanente Medicaid	$480.19
Rate for Payer: MDX Hawaii PPO	$503.43
Rate for Payer: UnitedHealthcare Medicaid	$480.19
Rate for Payer: University Health Alliance Commercial	$5,923.00

Room Chg - Private SNF

Facility

$519.00

Hospital Charge Code	R&B
Hospital Revenue Code	111
Min. Negotiated Rate	$441.15
Max. Negotiated Rate	$2,350.00
Rate for Payer: AlohaCare Medicaid	$480.19
Rate for Payer: Cash Price	$337.35
Rate for Payer: Cash Price	$337.35
Rate for Payer: Hawaii Medical Service Association ABD	$774.17
Rate for Payer: Hawaii Medical Service Association Commercial	$890.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$774.17
Rate for Payer: Hawaii Western Management Group Commercial	$2,350.00
Rate for Payer: Health Management Network Commercial	$441.15
Rate for Payer: Kaiser Permanente Commercial	$467.10
Rate for Payer: Kaiser Permanente Medicaid	$480.19
Rate for Payer: MDX Hawaii PPO	$503.43
Rate for Payer: UnitedHealthcare Medicaid	$480.19
Rate for Payer: University Health Alliance Commercial	$2,320.00

Room Chg - Private TB

Facility

$3,050.00

Hospital Charge Code	R&B
Hospital Revenue Code	111
Min. Negotiated Rate	$480.19
Max. Negotiated Rate	$7,250.00
Rate for Payer: AlohaCare Medicaid	$480.19
Rate for Payer: Cash Price	$1,982.50
Rate for Payer: Cash Price	$1,982.50
Rate for Payer: Hawaii Medical Service Association ABD	$480.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$480.19
Rate for Payer: Hawaii Western Management Group Commercial	$7,250.00
Rate for Payer: Health Management Network Commercial	$2,592.50
Rate for Payer: Kaiser Permanente Commercial	$2,745.00
Rate for Payer: Kaiser Permanente Medicaid	$480.19
Rate for Payer: MDX Hawaii PPO	$2,958.50
Rate for Payer: UnitedHealthcare Medicaid	$480.19
Rate for Payer: University Health Alliance Commercial	$5,923.00

Room Chg - Semi Pvt ICF

Facility

$509.00

Hospital Charge Code	R&B
Hospital Revenue Code	121
Min. Negotiated Rate	$432.65
Max. Negotiated Rate	$7,250.00
Rate for Payer: AlohaCare Medicaid	$480.19
Rate for Payer: Cash Price	$330.85
Rate for Payer: Cash Price	$330.85
Rate for Payer: Hawaii Medical Service Association ABD	$774.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$774.17
Rate for Payer: Hawaii Western Management Group Commercial	$7,250.00
Rate for Payer: Health Management Network Commercial	$432.65
Rate for Payer: Kaiser Permanente Commercial	$458.10
Rate for Payer: Kaiser Permanente Medicaid	$480.19
Rate for Payer: MDX Hawaii PPO	$493.73
Rate for Payer: UnitedHealthcare Medicaid	$480.19
Rate for Payer: University Health Alliance Commercial	$5,923.00

Room Chg - Semi Pvt SNF

Facility

$509.00

Hospital Charge Code	R&B
Hospital Revenue Code	121
Min. Negotiated Rate	$432.65
Max. Negotiated Rate	$2,350.00
Rate for Payer: AlohaCare Medicaid	$480.19
Rate for Payer: Cash Price	$330.85
Rate for Payer: Cash Price	$330.85
Rate for Payer: Hawaii Medical Service Association ABD	$774.17
Rate for Payer: Hawaii Medical Service Association Commercial	$890.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$774.17
Rate for Payer: Hawaii Western Management Group Commercial	$2,350.00
Rate for Payer: Health Management Network Commercial	$432.65
Rate for Payer: Kaiser Permanente Commercial	$458.10
Rate for Payer: Kaiser Permanente Medicaid	$480.19
Rate for Payer: MDX Hawaii PPO	$493.73
Rate for Payer: UnitedHealthcare Medicaid	$480.19
Rate for Payer: University Health Alliance Commercial	$2,320.00

Room Chg - Semi Pvt TB

Facility

$3,050.00

Hospital Charge Code	R&B
Hospital Revenue Code	121
Min. Negotiated Rate	$480.19
Max. Negotiated Rate	$7,250.00
Rate for Payer: AlohaCare Medicaid	$480.19
Rate for Payer: Cash Price	$1,982.50
Rate for Payer: Cash Price	$1,982.50
Rate for Payer: Hawaii Medical Service Association ABD	$480.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$480.19
Rate for Payer: Hawaii Western Management Group Commercial	$7,250.00
Rate for Payer: Health Management Network Commercial	$2,592.50
Rate for Payer: Kaiser Permanente Commercial	$2,745.00
Rate for Payer: Kaiser Permanente Medicaid	$480.19
Rate for Payer: MDX Hawaii PPO	$2,958.50
Rate for Payer: UnitedHealthcare Medicaid	$480.19
Rate for Payer: University Health Alliance Commercial	$5,923.00

Room Chg Ward ICF

Facility

$499.00

Hospital Charge Code	R&B
Hospital Revenue Code	150
Min. Negotiated Rate	$424.15
Max. Negotiated Rate	$7,250.00
Rate for Payer: AlohaCare Medicaid	$480.19
Rate for Payer: Cash Price	$324.35
Rate for Payer: Cash Price	$324.35
Rate for Payer: Hawaii Medical Service Association ABD	$774.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$774.17
Rate for Payer: Hawaii Western Management Group Commercial	$7,250.00
Rate for Payer: Health Management Network Commercial	$424.15
Rate for Payer: Kaiser Permanente Commercial	$449.10
Rate for Payer: Kaiser Permanente Medicaid	$480.19
Rate for Payer: MDX Hawaii PPO	$484.03
Rate for Payer: UnitedHealthcare Medicaid	$480.19
Rate for Payer: University Health Alliance Commercial	$5,923.00

Room Chg Ward SNF

Facility

$499.00

Hospital Charge Code	R&B
Hospital Revenue Code	150
Min. Negotiated Rate	$424.15
Max. Negotiated Rate	$2,350.00
Rate for Payer: AlohaCare Medicaid	$480.19
Rate for Payer: Cash Price	$324.35
Rate for Payer: Cash Price	$324.35
Rate for Payer: Hawaii Medical Service Association ABD	$774.17
Rate for Payer: Hawaii Medical Service Association Commercial	$890.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$774.17
Rate for Payer: Hawaii Western Management Group Commercial	$2,350.00
Rate for Payer: Health Management Network Commercial	$424.15
Rate for Payer: Kaiser Permanente Commercial	$449.10
Rate for Payer: Kaiser Permanente Medicaid	$480.19
Rate for Payer: MDX Hawaii PPO	$484.03
Rate for Payer: UnitedHealthcare Medicaid	$480.19
Rate for Payer: University Health Alliance Commercial	$2,320.00

RSV - Administration

Facility

$162.00

Service Code	HCPCS 90471
Hospital Charge Code	RSV-ADM
Hospital Revenue Code	771
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$157.14
Rate for Payer: AlohaCare Medicaid	$81.00
Rate for Payer: Cash Price	$105.30
Rate for Payer: Cash Price	$105.30
Rate for Payer: Hawaii Medical Service Association ABD	$4.00
Rate for Payer: Hawaii Medical Service Association Commercial	$106.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.56
Rate for Payer: Hawaii Western Management Group Commercial	$153.90
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: Kaiser Permanente Commercial	$145.80
Rate for Payer: Kaiser Permanente Medicaid	$82.62
Rate for Payer: MDX Hawaii PPO	$157.14
Rate for Payer: UnitedHealthcare Medicaid	$4.00
Rate for Payer: University Health Alliance Commercial	$118.08

RSV - Administration

Facility

$162.00

Service Code	HCPCS 90471
Hospital Charge Code	RSV-ADM
Hospital Revenue Code	771
Min. Negotiated Rate	$137.70
Max. Negotiated Rate	$157.14
Rate for Payer: Cash Price	$105.30
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: Kaiser Permanente Commercial	$145.80
Rate for Payer: MDX Hawaii PPO	$157.14

SALIVARY GLAND PROCEDURES

Facility

$21,758.44

Service Code	MSDRG 139
Min. Negotiated Rate	$12,614.11
Max. Negotiated Rate	$21,758.44
Rate for Payer: AlohaCare Medicare	$12,614.11
Rate for Payer: Hawaii Medical Service Association Commercial	$21,758.44
Rate for Payer: Hawaii Medical Service Association Medicare	$12,614.11
Rate for Payer: Humana Medicare	$12,614.11
Rate for Payer: Kaiser Permanente Medicare	$12,614.11
Rate for Payer: Ohana Health Plan Medicare	$12,614.11
Rate for Payer: UnitedHealthcare Medicare	$12,614.11

SARS-CoV-2 (COVID- 19)

Facility

$312.00

Service Code	HCPCS 87635
Hospital Charge Code	87635
Hospital Revenue Code	306
Min. Negotiated Rate	$265.20
Max. Negotiated Rate	$302.64
Rate for Payer: Cash Price	$202.80
Rate for Payer: Health Management Network Commercial	$265.20
Rate for Payer: Kaiser Permanente Commercial	$280.80
Rate for Payer: MDX Hawaii PPO	$302.64

SARS-CoV-2 (COVID- 19)

Facility

$312.00

Service Code	HCPCS 87635
Hospital Charge Code	87635
Hospital Revenue Code	306
Min. Negotiated Rate	$51.31
Max. Negotiated Rate	$302.64
Rate for Payer: AlohaCare Medicaid	$156.00
Rate for Payer: Cash Price	$202.80
Rate for Payer: Cash Price	$202.80
Rate for Payer: Hawaii Medical Service Association ABD	$51.31
Rate for Payer: Hawaii Medical Service Association Commercial	$64.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$51.31
Rate for Payer: Hawaii Western Management Group Commercial	$51.31
Rate for Payer: Health Management Network Commercial	$265.20
Rate for Payer: Kaiser Permanente Commercial	$280.80
Rate for Payer: Kaiser Permanente Medicaid	$159.12
Rate for Payer: MDX Hawaii PPO	$302.64
Rate for Payer: UnitedHealthcare Medicaid	$51.31
Rate for Payer: University Health Alliance Commercial	$94.96

Know your out-of-pocket cost for care.

All Charges