Leahi Hospital

All Charges

Charge

Type

Setting

Price

Sars-Cov-2 Flu A/B Amp PR

Facility

$390.00

Service Code	HCPCS 87636
Hospital Charge Code	87636
Hospital Revenue Code	306
Min. Negotiated Rate	$331.50
Max. Negotiated Rate	$378.30
Rate for Payer: Cash Price	$253.50
Rate for Payer: Health Management Network Commercial	$331.50
Rate for Payer: Kaiser Permanente Commercial	$351.00
Rate for Payer: MDX Hawaii PPO	$378.30

Sars-Cov-2 Flu A/B Amp PR

Facility

$390.00

Service Code	HCPCS 87636
Hospital Charge Code	87636
Hospital Revenue Code	306
Min. Negotiated Rate	$142.63
Max. Negotiated Rate	$378.30
Rate for Payer: AlohaCare Medicaid	$195.00
Rate for Payer: Cash Price	$253.50
Rate for Payer: Cash Price	$253.50
Rate for Payer: Hawaii Medical Service Association ABD	$142.63
Rate for Payer: Hawaii Medical Service Association Commercial	$178.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$142.63
Rate for Payer: Hawaii Western Management Group Commercial	$142.63
Rate for Payer: Health Management Network Commercial	$331.50
Rate for Payer: Kaiser Permanente Commercial	$351.00
Rate for Payer: Kaiser Permanente Medicaid	$198.90
Rate for Payer: MDX Hawaii PPO	$378.30
Rate for Payer: UnitedHealthcare Medicaid	$142.63
Rate for Payer: University Health Alliance Commercial	$284.27

SEIZURES WITH MCC

Facility

$22,730.22

Service Code	MSDRG 100
Min. Negotiated Rate	$19,523.68
Max. Negotiated Rate	$22,730.22
Rate for Payer: AlohaCare Medicare	$19,523.68
Rate for Payer: Hawaii Medical Service Association Commercial	$22,730.22
Rate for Payer: Hawaii Medical Service Association Medicare	$19,523.68
Rate for Payer: Humana Medicare	$19,523.68
Rate for Payer: Kaiser Permanente Medicare	$19,523.68
Rate for Payer: Ohana Health Plan Medicare	$19,523.68
Rate for Payer: UnitedHealthcare Medicare	$19,523.68

SEIZURES WITHOUT MCC

Facility

$19,625.26

Service Code	MSDRG 101
Min. Negotiated Rate	$9,331.27
Max. Negotiated Rate	$19,625.26
Rate for Payer: AlohaCare Medicare	$9,331.27
Rate for Payer: Hawaii Medical Service Association Commercial	$19,625.26
Rate for Payer: Hawaii Medical Service Association Medicare	$9,331.27
Rate for Payer: Humana Medicare	$9,331.27
Rate for Payer: Kaiser Permanente Medicare	$9,331.27
Rate for Payer: Ohana Health Plan Medicare	$9,331.27
Rate for Payer: UnitedHealthcare Medicare	$9,331.27

Self care management training

Facility

$233.00

Service Code	HCPCS 97535 GN
Hospital Charge Code	ST97535
Hospital Revenue Code	440
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$226.01
Rate for Payer: AlohaCare Medicaid	$116.50
Rate for Payer: Cash Price	$151.45
Rate for Payer: Cash Price	$151.45
Rate for Payer: Hawaii Western Management Group Commercial	$221.35
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: Kaiser Permanente Commercial	$209.70
Rate for Payer: Kaiser Permanente Medicaid	$118.83
Rate for Payer: MDX Hawaii PPO	$226.01
Rate for Payer: UnitedHealthcare Medicaid	$19.20
Rate for Payer: University Health Alliance Commercial	$169.83

Self care management training

Facility

$233.00

Service Code	HCPCS 97535 GN
Hospital Charge Code	ST97535
Hospital Revenue Code	440
Min. Negotiated Rate	$198.05
Max. Negotiated Rate	$226.01
Rate for Payer: Cash Price	$151.45
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: Kaiser Permanente Commercial	$209.70
Rate for Payer: MDX Hawaii PPO	$226.01

Self Care Management Training

Facility

$233.00

Service Code	HCPCS 97535 GO
Hospital Charge Code	OT97535
Hospital Revenue Code	430
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$226.01
Rate for Payer: AlohaCare Medicaid	$116.50
Rate for Payer: Cash Price	$151.45
Rate for Payer: Cash Price	$151.45
Rate for Payer: Hawaii Western Management Group Commercial	$221.35
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: Kaiser Permanente Commercial	$209.70
Rate for Payer: Kaiser Permanente Medicaid	$118.83
Rate for Payer: MDX Hawaii PPO	$226.01
Rate for Payer: UnitedHealthcare Medicaid	$19.20
Rate for Payer: University Health Alliance Commercial	$169.83

Self Care Management Training

Facility

$233.00

Service Code	HCPCS 97535 GP
Hospital Charge Code	PT97535
Hospital Revenue Code	420
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$226.01
Rate for Payer: AlohaCare Medicaid	$116.50
Rate for Payer: Cash Price	$151.45
Rate for Payer: Cash Price	$151.45
Rate for Payer: Hawaii Western Management Group Commercial	$221.35
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: Kaiser Permanente Commercial	$209.70
Rate for Payer: Kaiser Permanente Medicaid	$118.83
Rate for Payer: MDX Hawaii PPO	$226.01
Rate for Payer: UnitedHealthcare Medicaid	$19.20
Rate for Payer: University Health Alliance Commercial	$169.83

Self Care Management Training

Facility

$233.00

Service Code	HCPCS 97535 GP
Hospital Charge Code	PT97535
Hospital Revenue Code	420
Min. Negotiated Rate	$198.05
Max. Negotiated Rate	$226.01
Rate for Payer: Cash Price	$151.45
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: Kaiser Permanente Commercial	$209.70
Rate for Payer: MDX Hawaii PPO	$226.01

Self Care Management Training

Facility

$233.00

Service Code	HCPCS 97535 GO
Hospital Charge Code	OT97535
Hospital Revenue Code	430
Min. Negotiated Rate	$198.05
Max. Negotiated Rate	$226.01
Rate for Payer: Cash Price	$151.45
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: Kaiser Permanente Commercial	$209.70
Rate for Payer: MDX Hawaii PPO	$226.01

Sensitivity Mic

Facility

$184.00

Service Code	HCPCS 87186
Hospital Charge Code	87186
Hospital Revenue Code	306
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$178.48
Rate for Payer: AlohaCare Medicaid	$92.00
Rate for Payer: Cash Price	$119.60
Rate for Payer: Cash Price	$119.60
Rate for Payer: Hawaii Medical Service Association ABD	$11.94
Rate for Payer: Hawaii Medical Service Association Commercial	$10.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.54
Rate for Payer: Hawaii Western Management Group Commercial	$8.65
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: Kaiser Permanente Medicaid	$93.84
Rate for Payer: MDX Hawaii PPO	$178.48
Rate for Payer: UnitedHealthcare Medicaid	$11.94
Rate for Payer: University Health Alliance Commercial	$22.35

Sensitivity Mic

Facility

$184.00

Service Code	HCPCS 87186
Hospital Charge Code	87186
Hospital Revenue Code	306
Min. Negotiated Rate	$156.40
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$119.60
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: MDX Hawaii PPO	$178.48

Sensitivity mycobacter

Facility

$96.00

Service Code	HCPCS 87190
Hospital Charge Code	87190
Hospital Revenue Code	306
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$62.40
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12

Sensitivity mycobacter

Facility

$96.00

Service Code	HCPCS 87190
Hospital Charge Code	87190
Hospital Revenue Code	306
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$93.12
Rate for Payer: AlohaCare Medicaid	$48.00
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Hawaii Medical Service Association ABD	$7.81
Rate for Payer: Hawaii Medical Service Association Commercial	$9.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.20
Rate for Payer: Hawaii Western Management Group Commercial	$7.31
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: UnitedHealthcare Medicaid	$7.81
Rate for Payer: University Health Alliance Commercial	$14.62

SEPTIC ARTHRITIS WITH CC

Facility

$24,460.46

Service Code	MSDRG 549
Min. Negotiated Rate	$12,333.21
Max. Negotiated Rate	$24,460.46
Rate for Payer: AlohaCare Medicare	$12,333.21
Rate for Payer: Hawaii Medical Service Association Commercial	$24,460.46
Rate for Payer: Hawaii Medical Service Association Medicare	$12,333.21
Rate for Payer: Humana Medicare	$12,333.21
Rate for Payer: Kaiser Permanente Medicare	$12,333.21
Rate for Payer: Ohana Health Plan Medicare	$12,333.21
Rate for Payer: UnitedHealthcare Medicare	$12,333.21

SEPTIC ARTHRITIS WITH MCC

Facility

$24,460.46

Service Code	MSDRG 548
Min. Negotiated Rate	$19,465.54
Max. Negotiated Rate	$24,460.46
Rate for Payer: AlohaCare Medicare	$19,465.54
Rate for Payer: Hawaii Medical Service Association Commercial	$24,460.46
Rate for Payer: Hawaii Medical Service Association Medicare	$19,465.54
Rate for Payer: Humana Medicare	$19,465.54
Rate for Payer: Kaiser Permanente Medicare	$19,465.54
Rate for Payer: Ohana Health Plan Medicare	$19,465.54
Rate for Payer: UnitedHealthcare Medicare	$19,465.54

SEPTIC ARTHRITIS WITHOUT CC/MCC

Facility

$24,460.46

Service Code	MSDRG 550
Min. Negotiated Rate	$9,050.40
Max. Negotiated Rate	$24,460.46
Rate for Payer: AlohaCare Medicare	$9,050.40
Rate for Payer: Hawaii Medical Service Association Commercial	$24,460.46
Rate for Payer: Hawaii Medical Service Association Medicare	$9,050.40
Rate for Payer: Humana Medicare	$9,050.40
Rate for Payer: Kaiser Permanente Medicare	$9,050.40
Rate for Payer: Ohana Health Plan Medicare	$9,050.40
Rate for Payer: UnitedHealthcare Medicare	$9,050.40

SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS

Facility

$182,695.02

Service Code	MSDRG 870
Min. Negotiated Rate	$68,554.09
Max. Negotiated Rate	$182,695.02
Rate for Payer: AlohaCare Medicare	$68,554.09
Rate for Payer: Hawaii Medical Service Association Commercial	$182,695.02
Rate for Payer: Hawaii Medical Service Association Medicare	$68,554.09
Rate for Payer: Humana Medicare	$68,554.09
Rate for Payer: Kaiser Permanente Medicare	$68,554.09
Rate for Payer: Ohana Health Plan Medicare	$68,554.09
Rate for Payer: UnitedHealthcare Medicare	$68,554.09

SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC

Facility

$40,814.84

Service Code	MSDRG 871
Min. Negotiated Rate	$19,579.87
Max. Negotiated Rate	$40,814.84
Rate for Payer: AlohaCare Medicare	$19,579.87
Rate for Payer: Hawaii Medical Service Association Commercial	$40,814.84
Rate for Payer: Hawaii Medical Service Association Medicare	$19,579.87
Rate for Payer: Humana Medicare	$19,579.87
Rate for Payer: Kaiser Permanente Medicare	$19,579.87
Rate for Payer: Ohana Health Plan Medicare	$19,579.87
Rate for Payer: UnitedHealthcare Medicare	$19,579.87

SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC

Facility

$40,791.14

Service Code	MSDRG 872
Min. Negotiated Rate	$10,520.81
Max. Negotiated Rate	$40,791.14
Rate for Payer: AlohaCare Medicare	$10,520.81
Rate for Payer: Hawaii Medical Service Association Commercial	$40,791.14
Rate for Payer: Hawaii Medical Service Association Medicare	$10,520.81
Rate for Payer: Humana Medicare	$10,520.81
Rate for Payer: Kaiser Permanente Medicare	$10,520.81
Rate for Payer: Ohana Health Plan Medicare	$10,520.81
Rate for Payer: UnitedHealthcare Medicare	$10,520.81

SGOT

Facility

$112.00

Service Code	HCPCS 84450
Hospital Charge Code	84450
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$108.64
Rate for Payer: AlohaCare Medicaid	$56.00
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cash Price	$72.80
Rate for Payer: Hawaii Medical Service Association ABD	$7.14
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.50
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$95.20
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: Kaiser Permanente Medicaid	$57.12
Rate for Payer: MDX Hawaii PPO	$108.64
Rate for Payer: UnitedHealthcare Medicaid	$7.14
Rate for Payer: University Health Alliance Commercial	$13.36

SGOT

Facility

$112.00

Service Code	HCPCS 84450
Hospital Charge Code	84450
Hospital Revenue Code	301
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$108.64
Rate for Payer: Cash Price	$72.80
Rate for Payer: Health Management Network Commercial	$95.20
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: MDX Hawaii PPO	$108.64

SGPT

Facility

$113.00

Service Code	HCPCS 84460
Hospital Charge Code	84460
Hospital Revenue Code	301
Min. Negotiated Rate	$96.05
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$73.45
Rate for Payer: Health Management Network Commercial	$96.05
Rate for Payer: Kaiser Permanente Commercial	$101.70
Rate for Payer: MDX Hawaii PPO	$109.61

SGPT

Facility

$113.00

Service Code	HCPCS 84460
Hospital Charge Code	84460
Hospital Revenue Code	301
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$109.61
Rate for Payer: AlohaCare Medicaid	$56.50
Rate for Payer: Cash Price	$73.45
Rate for Payer: Cash Price	$73.45
Rate for Payer: Hawaii Medical Service Association ABD	$7.32
Rate for Payer: Hawaii Medical Service Association Commercial	$6.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.69
Rate for Payer: Hawaii Western Management Group Commercial	$5.30
Rate for Payer: Health Management Network Commercial	$96.05
Rate for Payer: Kaiser Permanente Commercial	$101.70
Rate for Payer: Kaiser Permanente Medicaid	$57.63
Rate for Payer: MDX Hawaii PPO	$109.61
Rate for Payer: UnitedHealthcare Medicaid	$7.32
Rate for Payer: University Health Alliance Commercial	$13.69

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC

Facility

$23,180.56

Service Code	MSDRG 511
Min. Negotiated Rate	$20,929.06
Max. Negotiated Rate	$23,180.56
Rate for Payer: AlohaCare Medicare	$20,929.06
Rate for Payer: Hawaii Medical Service Association Commercial	$23,180.56
Rate for Payer: Hawaii Medical Service Association Medicare	$20,929.06
Rate for Payer: Humana Medicare	$20,929.06
Rate for Payer: Kaiser Permanente Medicare	$20,929.06
Rate for Payer: Ohana Health Plan Medicare	$20,929.06
Rate for Payer: UnitedHealthcare Medicare	$20,929.06

Know your out-of-pocket cost for care.

All Charges