Leahi Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$30,203.94

Service Code	MSDRG 510
Min. Negotiated Rate	$23,180.56
Max. Negotiated Rate	$30,203.94
Rate for Payer: AlohaCare Medicare	$30,203.94
Rate for Payer: Hawaii Medical Service Association Commercial	$23,180.56
Rate for Payer: Hawaii Medical Service Association Medicare	$30,203.94
Rate for Payer: Humana Medicare	$30,203.94
Rate for Payer: Kaiser Permanente Medicare	$30,203.94
Rate for Payer: Ohana Health Plan Medicare	$30,203.94
Rate for Payer: UnitedHealthcare Medicare	$30,203.94

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$21,782.14

Service Code	MSDRG 512
Min. Negotiated Rate	$16,750.38
Max. Negotiated Rate	$21,782.14
Rate for Payer: AlohaCare Medicare	$16,750.38
Rate for Payer: Hawaii Medical Service Association Commercial	$21,782.14
Rate for Payer: Hawaii Medical Service Association Medicare	$16,750.38
Rate for Payer: Humana Medicare	$16,750.38
Rate for Payer: Kaiser Permanente Medicare	$16,750.38
Rate for Payer: Ohana Health Plan Medicare	$16,750.38
Rate for Payer: UnitedHealthcare Medicare	$16,750.38

Shoulder strapping

Facility

$467.00

Service Code	HCPCS 29240 GO
Hospital Charge Code	OT29240
Hospital Revenue Code	430
Min. Negotiated Rate	$396.95
Max. Negotiated Rate	$452.99
Rate for Payer: Cash Price	$303.55
Rate for Payer: Health Management Network Commercial	$396.95
Rate for Payer: Kaiser Permanente Commercial	$420.30
Rate for Payer: MDX Hawaii PPO	$452.99

Shoulder strapping

Facility

$467.00

Service Code	HCPCS 29240 GO
Hospital Charge Code	OT29240
Hospital Revenue Code	430
Min. Negotiated Rate	$27.92
Max. Negotiated Rate	$452.99
Rate for Payer: AlohaCare Medicaid	$233.50
Rate for Payer: Cash Price	$303.55
Rate for Payer: Cash Price	$303.55
Rate for Payer: Hawaii Western Management Group Commercial	$443.65
Rate for Payer: Health Management Network Commercial	$396.95
Rate for Payer: Kaiser Permanente Commercial	$420.30
Rate for Payer: Kaiser Permanente Medicaid	$238.17
Rate for Payer: MDX Hawaii PPO	$452.99
Rate for Payer: UnitedHealthcare Medicaid	$27.92
Rate for Payer: University Health Alliance Commercial	$340.40

SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$13,462.64

Service Code	MSDRG 555
Min. Negotiated Rate	$10,499.99
Max. Negotiated Rate	$13,462.64
Rate for Payer: AlohaCare Medicare	$13,462.64
Rate for Payer: Hawaii Medical Service Association Commercial	$10,499.99
Rate for Payer: Hawaii Medical Service Association Medicare	$13,462.64
Rate for Payer: Humana Medicare	$13,462.64
Rate for Payer: Kaiser Permanente Medicare	$13,462.64
Rate for Payer: Ohana Health Plan Medicare	$13,462.64
Rate for Payer: UnitedHealthcare Medicare	$13,462.64

SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC

Facility

$10,499.99

Service Code	MSDRG 556
Min. Negotiated Rate	$8,621.69
Max. Negotiated Rate	$10,499.99
Rate for Payer: AlohaCare Medicare	$8,621.69
Rate for Payer: Hawaii Medical Service Association Commercial	$10,499.99
Rate for Payer: Hawaii Medical Service Association Medicare	$8,621.69
Rate for Payer: Humana Medicare	$8,621.69
Rate for Payer: Kaiser Permanente Medicare	$8,621.69
Rate for Payer: Ohana Health Plan Medicare	$8,621.69
Rate for Payer: UnitedHealthcare Medicare	$8,621.69

SIGNS AND SYMPTOMS WITH MCC

Facility

$14,387.11

Service Code	MSDRG 947
Min. Negotiated Rate	$12,946.22
Max. Negotiated Rate	$14,387.11
Rate for Payer: AlohaCare Medicare	$12,946.22
Rate for Payer: Hawaii Medical Service Association Commercial	$14,387.11
Rate for Payer: Hawaii Medical Service Association Medicare	$12,946.22
Rate for Payer: Humana Medicare	$12,946.22
Rate for Payer: Kaiser Permanente Medicare	$12,946.22
Rate for Payer: Ohana Health Plan Medicare	$12,946.22
Rate for Payer: UnitedHealthcare Medicare	$12,946.22

SIGNS AND SYMPTOMS WITHOUT MCC

Facility

$13,676.05

Service Code	MSDRG 948
Min. Negotiated Rate	$8,325.04
Max. Negotiated Rate	$13,676.05
Rate for Payer: AlohaCare Medicare	$8,325.04
Rate for Payer: Hawaii Medical Service Association Commercial	$13,676.05
Rate for Payer: Hawaii Medical Service Association Medicare	$8,325.04
Rate for Payer: Humana Medicare	$8,325.04
Rate for Payer: Kaiser Permanente Medicare	$8,325.04
Rate for Payer: Ohana Health Plan Medicare	$8,325.04
Rate for Payer: UnitedHealthcare Medicare	$8,325.04

SIMPLE PNEUMONIA AND PLEURISY WITH CC

Facility

$23,796.81

Service Code	MSDRG 194
Min. Negotiated Rate	$8,378.26
Max. Negotiated Rate	$23,796.81
Rate for Payer: AlohaCare Medicare	$8,378.26
Rate for Payer: Hawaii Medical Service Association Commercial	$23,796.81
Rate for Payer: Hawaii Medical Service Association Medicare	$8,378.26
Rate for Payer: Humana Medicare	$8,378.26
Rate for Payer: Kaiser Permanente Medicare	$8,378.26
Rate for Payer: Ohana Health Plan Medicare	$8,378.26
Rate for Payer: UnitedHealthcare Medicare	$8,378.26

SIMPLE PNEUMONIA AND PLEURISY WITH MCC

Facility

$24,626.38

Service Code	MSDRG 193
Min. Negotiated Rate	$13,389.71
Max. Negotiated Rate	$24,626.38
Rate for Payer: AlohaCare Medicare	$13,389.71
Rate for Payer: Hawaii Medical Service Association Commercial	$24,626.38
Rate for Payer: Hawaii Medical Service Association Medicare	$13,389.71
Rate for Payer: Humana Medicare	$13,389.71
Rate for Payer: Kaiser Permanente Medicare	$13,389.71
Rate for Payer: Ohana Health Plan Medicare	$13,389.71
Rate for Payer: UnitedHealthcare Medicare	$13,389.71

SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC

Facility

$18,937.90

Service Code	MSDRG 195
Min. Negotiated Rate	$6,629.92
Max. Negotiated Rate	$18,937.90
Rate for Payer: AlohaCare Medicare	$6,629.92
Rate for Payer: Hawaii Medical Service Association Commercial	$18,937.90
Rate for Payer: Hawaii Medical Service Association Medicare	$6,629.92
Rate for Payer: Humana Medicare	$6,629.92
Rate for Payer: Kaiser Permanente Medicare	$6,629.92
Rate for Payer: Ohana Health Plan Medicare	$6,629.92
Rate for Payer: UnitedHealthcare Medicare	$6,629.92

SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT

Facility

$696,862.50

Service Code	MSDRG 008
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$696,862.50
Rate for Payer: AlohaCare Medicare	$55,671.17
Rate for Payer: Hawaii Medical Service Association Commercial	$696,862.50
Rate for Payer: Hawaii Medical Service Association Medicare	$55,671.17
Rate for Payer: Kaiser Permanente Medicare	$55,671.17
Rate for Payer: Ohana Health Plan Medicare	$55,671.17
Rate for Payer: UnitedHealthcare Medicare	$55,671.17
Rate for Payer: University Health Alliance Commercial	$10,400.00

SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS

Facility

$70,749.86

Service Code	MSDRG 019
Min. Negotiated Rate	$70,749.86
Max. Negotiated Rate	$70,749.86
Rate for Payer: AlohaCare Medicare	$70,749.86
Rate for Payer: Hawaii Medical Service Association Medicare	$70,749.86
Rate for Payer: Humana Medicare	$70,749.86
Rate for Payer: Kaiser Permanente Medicare	$70,749.86
Rate for Payer: Ohana Health Plan Medicare	$70,749.86
Rate for Payer: UnitedHealthcare Medicare	$70,749.86

SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL

Facility

$115,594.65

Service Code	MSDRG 402
Min. Negotiated Rate	$40,059.29
Max. Negotiated Rate	$115,594.65
Rate for Payer: AlohaCare Medicare	$40,059.29
Rate for Payer: Hawaii Medical Service Association Commercial	$115,594.65
Rate for Payer: Hawaii Medical Service Association Medicare	$40,059.29
Rate for Payer: Humana Medicare	$40,059.29
Rate for Payer: Kaiser Permanente Medicare	$40,059.29
Rate for Payer: Ohana Health Plan Medicare	$40,059.29
Rate for Payer: UnitedHealthcare Medicare	$40,059.29

SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$52,960.94

Service Code	MSDRG 450
Min. Negotiated Rate	$52,960.94
Max. Negotiated Rate	$52,960.94
Rate for Payer: AlohaCare Medicare	$52,960.94
Rate for Payer: Hawaii Medical Service Association Medicare	$52,960.94
Rate for Payer: Humana Medicare	$52,960.94
Rate for Payer: Kaiser Permanente Medicare	$52,960.94
Rate for Payer: Ohana Health Plan Medicare	$52,960.94
Rate for Payer: UnitedHealthcare Medicare	$52,960.94

SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC

Facility

$32,272.58

Service Code	MSDRG 451
Min. Negotiated Rate	$32,272.58
Max. Negotiated Rate	$32,272.58
Rate for Payer: AlohaCare Medicare	$32,272.58
Rate for Payer: Hawaii Medical Service Association Medicare	$32,272.58
Rate for Payer: Humana Medicare	$32,272.58
Rate for Payer: Kaiser Permanente Medicare	$32,272.58
Rate for Payer: Ohana Health Plan Medicare	$32,272.58
Rate for Payer: UnitedHealthcare Medicare	$32,272.58

SINUS AND MASTOID PROCEDURES WITH CC/MCC

Facility

$25,882.58

Service Code	MSDRG 135
Min. Negotiated Rate	$21,821.96
Max. Negotiated Rate	$25,882.58
Rate for Payer: AlohaCare Medicare	$21,821.96
Rate for Payer: Hawaii Medical Service Association Commercial	$25,882.58
Rate for Payer: Hawaii Medical Service Association Medicare	$21,821.96
Rate for Payer: Humana Medicare	$21,821.96
Rate for Payer: Kaiser Permanente Medicare	$21,821.96
Rate for Payer: Ohana Health Plan Medicare	$21,821.96
Rate for Payer: UnitedHealthcare Medicare	$21,821.96

SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC

Facility

$25,882.58

Service Code	MSDRG 136
Min. Negotiated Rate	$10,441.97
Max. Negotiated Rate	$25,882.58
Rate for Payer: AlohaCare Medicare	$10,441.97
Rate for Payer: Hawaii Medical Service Association Commercial	$25,882.58
Rate for Payer: Hawaii Medical Service Association Medicare	$10,441.97
Rate for Payer: Humana Medicare	$10,441.97
Rate for Payer: Kaiser Permanente Medicare	$10,441.97
Rate for Payer: Ohana Health Plan Medicare	$10,441.97
Rate for Payer: UnitedHealthcare Medicare	$10,441.97

SKIN DEBRIDEMENT WITH CC

Facility

$57,951.39

Service Code	MSDRG 571
Min. Negotiated Rate	$17,086.45
Max. Negotiated Rate	$57,951.39
Rate for Payer: AlohaCare Medicare	$17,086.45
Rate for Payer: Hawaii Medical Service Association Commercial	$57,951.39
Rate for Payer: Hawaii Medical Service Association Medicare	$17,086.45
Rate for Payer: Humana Medicare	$17,086.45
Rate for Payer: Kaiser Permanente Medicare	$17,086.45
Rate for Payer: Ohana Health Plan Medicare	$17,086.45
Rate for Payer: UnitedHealthcare Medicare	$17,086.45

SKIN DEBRIDEMENT WITH MCC

Facility

$60,795.63

Service Code	MSDRG 570
Min. Negotiated Rate	$29,421.43
Max. Negotiated Rate	$60,795.63
Rate for Payer: AlohaCare Medicare	$29,421.43
Rate for Payer: Hawaii Medical Service Association Commercial	$60,795.63
Rate for Payer: Hawaii Medical Service Association Medicare	$29,421.43
Rate for Payer: Humana Medicare	$29,421.43
Rate for Payer: Kaiser Permanente Medicare	$29,421.43
Rate for Payer: Ohana Health Plan Medicare	$29,421.43
Rate for Payer: UnitedHealthcare Medicare	$29,421.43

SKIN DEBRIDEMENT WITHOUT CC/MCC

Facility

$29,983.03

Service Code	MSDRG 572
Min. Negotiated Rate	$11,733.03
Max. Negotiated Rate	$29,983.03
Rate for Payer: AlohaCare Medicare	$11,733.03
Rate for Payer: Hawaii Medical Service Association Commercial	$29,983.03
Rate for Payer: Hawaii Medical Service Association Medicare	$11,733.03
Rate for Payer: Humana Medicare	$11,733.03
Rate for Payer: Kaiser Permanente Medicare	$11,733.03
Rate for Payer: Ohana Health Plan Medicare	$11,733.03
Rate for Payer: UnitedHealthcare Medicare	$11,733.03

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$59,894.95

Service Code	MSDRG 577
Min. Negotiated Rate	$26,559.43
Max. Negotiated Rate	$59,894.95
Rate for Payer: AlohaCare Medicare	$26,559.43
Rate for Payer: Hawaii Medical Service Association Commercial	$59,894.95
Rate for Payer: Hawaii Medical Service Association Medicare	$26,559.43
Rate for Payer: Humana Medicare	$26,559.43
Rate for Payer: Kaiser Permanente Medicare	$26,559.43
Rate for Payer: Ohana Health Plan Medicare	$26,559.43
Rate for Payer: UnitedHealthcare Medicare	$26,559.43

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$59,894.95

Service Code	MSDRG 576
Min. Negotiated Rate	$48,738.90
Max. Negotiated Rate	$59,894.95
Rate for Payer: AlohaCare Medicare	$48,738.90
Rate for Payer: Hawaii Medical Service Association Commercial	$59,894.95
Rate for Payer: Hawaii Medical Service Association Medicare	$48,738.90
Rate for Payer: Humana Medicare	$48,738.90
Rate for Payer: Kaiser Permanente Medicare	$48,738.90
Rate for Payer: Ohana Health Plan Medicare	$48,738.90
Rate for Payer: UnitedHealthcare Medicare	$48,738.90

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$16,267.48

Service Code	MSDRG 578
Min. Negotiated Rate	$14,150.09
Max. Negotiated Rate	$16,267.48
Rate for Payer: AlohaCare Medicare	$16,267.48
Rate for Payer: Hawaii Medical Service Association Commercial	$14,150.09
Rate for Payer: Hawaii Medical Service Association Medicare	$16,267.48
Rate for Payer: Humana Medicare	$16,267.48
Rate for Payer: Kaiser Permanente Medicare	$16,267.48
Rate for Payer: Ohana Health Plan Medicare	$16,267.48
Rate for Payer: UnitedHealthcare Medicare	$16,267.48

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$57,738.07

Service Code	MSDRG 574
Min. Negotiated Rate	$34,647.71
Max. Negotiated Rate	$57,738.07
Rate for Payer: AlohaCare Medicare	$34,647.71
Rate for Payer: Hawaii Medical Service Association Commercial	$57,738.07
Rate for Payer: Hawaii Medical Service Association Medicare	$34,647.71
Rate for Payer: Humana Medicare	$34,647.71
Rate for Payer: Kaiser Permanente Medicare	$34,647.71
Rate for Payer: Ohana Health Plan Medicare	$34,647.71
Rate for Payer: UnitedHealthcare Medicare	$34,647.71

Know your out-of-pocket cost for care.

All Charges