Leahi Hospital

All Charges

Charge

Type

Setting

Price

App short arm splint

Facility

$467.00

Service Code	HCPCS 29125 GO
Hospital Charge Code	OT29125
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

ATHEROSCLEROSIS WITH MCC

Facility

$14,197.50

Service Code	MSDRG 302
Min. Negotiated Rate	$12,228.74
Max. Negotiated Rate	$14,197.50
Rate for Payer: AlohaCare Medicare	$12,228.74
Rate for Payer: Hawaii Medical Service Association Commercial	$14,197.50
Rate for Payer: Hawaii Medical Service Association Medicare	$12,228.74
Rate for Payer: Humana Medicare	$12,228.74
Rate for Payer: Kaiser Permanente Medicare	$12,228.74
Rate for Payer: Ohana Health Plan Medicare	$12,228.74
Rate for Payer: UnitedHealthcare Medicare	$12,228.74

ATHEROSCLEROSIS WITHOUT MCC

Facility

$14,078.99

Service Code	MSDRG 303
Min. Negotiated Rate	$7,070.44
Max. Negotiated Rate	$14,078.99
Rate for Payer: AlohaCare Medicare	$7,070.44
Rate for Payer: Hawaii Medical Service Association Commercial	$14,078.99
Rate for Payer: Hawaii Medical Service Association Medicare	$7,070.44
Rate for Payer: Humana Medicare	$7,070.44
Rate for Payer: Kaiser Permanente Medicare	$7,070.44
Rate for Payer: Ohana Health Plan Medicare	$7,070.44
Rate for Payer: UnitedHealthcare Medicare	$7,070.44

AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC

Facility

$228,961.32

Service Code	MSDRG 016
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$228,961.32
Rate for Payer: AlohaCare Medicare	$58,875.14
Rate for Payer: Hawaii Medical Service Association Commercial	$228,961.32
Rate for Payer: Hawaii Medical Service Association Medicare	$58,875.14
Rate for Payer: Humana Medicare	$58,875.14
Rate for Payer: Kaiser Permanente Medicare	$58,875.14
Rate for Payer: Ohana Health Plan Medicare	$58,875.14
Rate for Payer: UnitedHealthcare Medicare	$58,875.14
Rate for Payer: University Health Alliance Commercial	$10,400.00

AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC

Facility

$228,961.32

Service Code	MSDRG 017
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$228,961.32
Rate for Payer: AlohaCare Medicare	$53,973.09
Rate for Payer: Hawaii Medical Service Association Commercial	$228,961.32
Rate for Payer: Hawaii Medical Service Association Medicare	$53,973.09
Rate for Payer: Humana Medicare	$53,973.09
Rate for Payer: Kaiser Permanente Medicare	$53,973.09
Rate for Payer: Ohana Health Plan Medicare	$53,973.09
Rate for Payer: UnitedHealthcare Medicare	$53,973.09
Rate for Payer: University Health Alliance Commercial	$10,400.00

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC

Facility

$46,361.11

Service Code	MSDRG 519
Min. Negotiated Rate	$20,148.52
Max. Negotiated Rate	$46,361.11
Rate for Payer: AlohaCare Medicare	$20,148.52
Rate for Payer: Hawaii Medical Service Association Commercial	$46,361.11
Rate for Payer: Hawaii Medical Service Association Medicare	$20,148.52
Rate for Payer: Humana Medicare	$20,148.52
Rate for Payer: Kaiser Permanente Medicare	$20,148.52
Rate for Payer: Ohana Health Plan Medicare	$20,148.52
Rate for Payer: UnitedHealthcare Medicare	$20,148.52

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR

Facility

$46,361.11

Service Code	MSDRG 518
Min. Negotiated Rate	$37,268.26
Max. Negotiated Rate	$46,361.11
Rate for Payer: AlohaCare Medicare	$37,268.26
Rate for Payer: Hawaii Medical Service Association Commercial	$46,361.11
Rate for Payer: Hawaii Medical Service Association Medicare	$37,268.26
Rate for Payer: Humana Medicare	$37,268.26
Rate for Payer: Kaiser Permanente Medicare	$37,268.26
Rate for Payer: Ohana Health Plan Medicare	$37,268.26
Rate for Payer: UnitedHealthcare Medicare	$37,268.26

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC

Facility

$29,911.92

Service Code	MSDRG 520
Min. Negotiated Rate	$15,158.75
Max. Negotiated Rate	$29,911.92
Rate for Payer: AlohaCare Medicare	$15,158.75
Rate for Payer: Hawaii Medical Service Association Commercial	$29,911.92
Rate for Payer: Hawaii Medical Service Association Medicare	$15,158.75
Rate for Payer: Humana Medicare	$15,158.75
Rate for Payer: Kaiser Permanente Medicare	$15,158.75
Rate for Payer: Ohana Health Plan Medicare	$15,158.75
Rate for Payer: UnitedHealthcare Medicare	$15,158.75

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC

Facility

$51,314.83

Service Code	MSDRG 095
Min. Negotiated Rate	$25,854.76
Max. Negotiated Rate	$51,314.83
Rate for Payer: AlohaCare Medicare	$25,854.76
Rate for Payer: Hawaii Medical Service Association Commercial	$51,314.83
Rate for Payer: Hawaii Medical Service Association Medicare	$25,854.76
Rate for Payer: Humana Medicare	$25,854.76
Rate for Payer: Kaiser Permanente Medicare	$25,854.76
Rate for Payer: Ohana Health Plan Medicare	$25,854.76
Rate for Payer: UnitedHealthcare Medicare	$25,854.76

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC

Facility

$51,314.83

Service Code	MSDRG 094
Min. Negotiated Rate	$35,120.77
Max. Negotiated Rate	$51,314.83
Rate for Payer: AlohaCare Medicare	$35,120.77
Rate for Payer: Hawaii Medical Service Association Commercial	$51,314.83
Rate for Payer: Hawaii Medical Service Association Medicare	$35,120.77
Rate for Payer: Humana Medicare	$35,120.77
Rate for Payer: Kaiser Permanente Medicare	$35,120.77
Rate for Payer: Ohana Health Plan Medicare	$35,120.77
Rate for Payer: UnitedHealthcare Medicare	$35,120.77

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$51,314.83

Service Code	MSDRG 096
Min. Negotiated Rate	$25,854.76
Max. Negotiated Rate	$51,314.83
Rate for Payer: AlohaCare Medicare	$25,854.76
Rate for Payer: Hawaii Medical Service Association Commercial	$51,314.83
Rate for Payer: Hawaii Medical Service Association Medicare	$25,854.76
Rate for Payer: Humana Medicare	$25,854.76
Rate for Payer: Kaiser Permanente Medicare	$25,854.76
Rate for Payer: Ohana Health Plan Medicare	$25,854.76
Rate for Payer: UnitedHealthcare Medicare	$25,854.76

Basic Metabolic Panel

Facility

$179.00

Service Code	HCPCS 80048
Hospital Charge Code	80048
Hospital Revenue Code	301
Min. Negotiated Rate	$8.46
Max. Negotiated Rate	$173.63
Rate for Payer: AlohaCare Medicaid	$89.50
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
Rate for Payer: Hawaii Medical Service Association ABD	$11.70
Rate for Payer: Hawaii Medical Service Association Commercial	$10.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.29
Rate for Payer: Hawaii Western Management Group Commercial	$8.46
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: UnitedHealthcare Medicaid	$11.70
Rate for Payer: University Health Alliance Commercial	$21.89

Basic Metabolic Panel

Facility

$179.00

Service Code	HCPCS 80048
Hospital Charge Code	80048
Hospital Revenue Code	301
Min. Negotiated Rate	$152.15
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$116.35
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63

BEHAVIORAL AND DEVELOPMENTAL DISORDERS

Facility

$20,888.66

Service Code	MSDRG 886
Min. Negotiated Rate	$14,126.39
Max. Negotiated Rate	$20,888.66
Rate for Payer: AlohaCare Medicare	$20,888.66
Rate for Payer: Hawaii Medical Service Association Commercial	$14,126.39
Rate for Payer: Hawaii Medical Service Association Medicare	$20,888.66
Rate for Payer: Humana Medicare	$20,888.66
Rate for Payer: Kaiser Permanente Medicare	$20,888.66
Rate for Payer: Ohana Health Plan Medicare	$20,888.66
Rate for Payer: UnitedHealthcare Medicare	$20,888.66

Behavioral and qualitative analysis

Facility

$769.00

Service Code	HCPCS 92524 GN
Hospital Charge Code	ST92524
Hospital Revenue Code	440
Min. Negotiated Rate	$653.65
Max. Negotiated Rate	$745.93
Rate for Payer: Cash Price	$499.85
Rate for Payer: Health Management Network Commercial	$653.65
Rate for Payer: Kaiser Permanente Commercial	$692.10
Rate for Payer: MDX Hawaii PPO	$745.93

Behavioral and qualitative analysis

Facility

$769.00

Service Code	HCPCS 92524 GN
Hospital Charge Code	ST92524
Hospital Revenue Code	440
Min. Negotiated Rate	$114.94
Max. Negotiated Rate	$745.93
Rate for Payer: AlohaCare Medicaid	$384.50
Rate for Payer: Cash Price	$499.85
Rate for Payer: Cash Price	$499.85
Rate for Payer: Hawaii Western Management Group Commercial	$730.55
Rate for Payer: Health Management Network Commercial	$653.65
Rate for Payer: Kaiser Permanente Commercial	$692.10
Rate for Payer: Kaiser Permanente Medicaid	$392.19
Rate for Payer: MDX Hawaii PPO	$745.93
Rate for Payer: UnitedHealthcare Medicaid	$114.94
Rate for Payer: University Health Alliance Commercial	$560.52

BENIGN PROSTATIC HYPERTROPHY WITH MCC

Facility

$25,005.61

Service Code	MSDRG 725
Min. Negotiated Rate	$11,968.57
Max. Negotiated Rate	$25,005.61
Rate for Payer: AlohaCare Medicare	$11,968.57
Rate for Payer: Hawaii Medical Service Association Commercial	$25,005.61
Rate for Payer: Hawaii Medical Service Association Medicare	$11,968.57
Rate for Payer: Humana Medicare	$11,968.57
Rate for Payer: Kaiser Permanente Medicare	$11,968.57
Rate for Payer: Ohana Health Plan Medicare	$11,968.57
Rate for Payer: UnitedHealthcare Medicare	$11,968.57

BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC

Facility

$25,005.61

Service Code	MSDRG 726
Min. Negotiated Rate	$7,551.40
Max. Negotiated Rate	$25,005.61
Rate for Payer: AlohaCare Medicare	$7,551.40
Rate for Payer: Hawaii Medical Service Association Commercial	$25,005.61
Rate for Payer: Hawaii Medical Service Association Medicare	$7,551.40
Rate for Payer: Humana Medicare	$7,551.40
Rate for Payer: Kaiser Permanente Medicare	$7,551.40
Rate for Payer: Ohana Health Plan Medicare	$7,551.40
Rate for Payer: UnitedHealthcare Medicare	$7,551.40

BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC

Facility

$66,318.20

Service Code	MSDRG 461
Min. Negotiated Rate	$54,866.96
Max. Negotiated Rate	$66,318.20
Rate for Payer: AlohaCare Medicare	$54,866.96
Rate for Payer: Hawaii Medical Service Association Commercial	$66,318.20
Rate for Payer: Hawaii Medical Service Association Medicare	$54,866.96
Rate for Payer: Humana Medicare	$54,866.96
Rate for Payer: Kaiser Permanente Medicare	$54,866.96
Rate for Payer: Ohana Health Plan Medicare	$54,866.96
Rate for Payer: UnitedHealthcare Medicare	$54,866.96

BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC

Facility

$66,318.20

Service Code	MSDRG 462
Min. Negotiated Rate	$26,651.08
Max. Negotiated Rate	$66,318.20
Rate for Payer: AlohaCare Medicare	$26,651.08
Rate for Payer: Hawaii Medical Service Association Commercial	$66,318.20
Rate for Payer: Hawaii Medical Service Association Medicare	$26,651.08
Rate for Payer: Humana Medicare	$26,651.08
Rate for Payer: Kaiser Permanente Medicare	$26,651.08
Rate for Payer: Ohana Health Plan Medicare	$26,651.08
Rate for Payer: UnitedHealthcare Medicare	$26,651.08

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC

Facility

$46,242.60

Service Code	MSDRG 409
Min. Negotiated Rate	$21,893.89
Max. Negotiated Rate	$46,242.60
Rate for Payer: AlohaCare Medicare	$21,893.89
Rate for Payer: Hawaii Medical Service Association Commercial	$46,242.60
Rate for Payer: Hawaii Medical Service Association Medicare	$21,893.89
Rate for Payer: Humana Medicare	$21,893.89
Rate for Payer: Kaiser Permanente Medicare	$21,893.89
Rate for Payer: Ohana Health Plan Medicare	$21,893.89
Rate for Payer: UnitedHealthcare Medicare	$21,893.89

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC

Facility

$46,242.60

Service Code	MSDRG 408
Min. Negotiated Rate	$35,576.10
Max. Negotiated Rate	$46,242.60
Rate for Payer: AlohaCare Medicare	$35,576.10
Rate for Payer: Hawaii Medical Service Association Commercial	$46,242.60
Rate for Payer: Hawaii Medical Service Association Medicare	$35,576.10
Rate for Payer: Humana Medicare	$35,576.10
Rate for Payer: Kaiser Permanente Medicare	$35,576.10
Rate for Payer: Ohana Health Plan Medicare	$35,576.10
Rate for Payer: UnitedHealthcare Medicare	$35,576.10

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$45,247.12

Service Code	MSDRG 410
Min. Negotiated Rate	$16,083.19
Max. Negotiated Rate	$45,247.12
Rate for Payer: AlohaCare Medicare	$16,083.19
Rate for Payer: Hawaii Medical Service Association Commercial	$45,247.12
Rate for Payer: Hawaii Medical Service Association Medicare	$16,083.19
Rate for Payer: Humana Medicare	$16,083.19
Rate for Payer: Kaiser Permanente Medicare	$16,083.19
Rate for Payer: Ohana Health Plan Medicare	$16,083.19
Rate for Payer: UnitedHealthcare Medicare	$16,083.19

Bilirubin direct

Facility

$86.00

Service Code	HCPCS 82248
Hospital Charge Code	82248
Hospital Revenue Code	301
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: MDX Hawaii PPO	$83.42

Bilirubin direct

Facility

$86.00

Service Code	HCPCS 82248
Hospital Charge Code	82248
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$43.00
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Hawaii Medical Service Association ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.29
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: University Health Alliance Commercial	$12.99

Know your out-of-pocket cost for care.

All Charges