Leahi Hospital

All Charges

Charge

Type

Setting

Price

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$65,002.23

Service Code	MSDRG 573
Min. Negotiated Rate	$60,890.44
Max. Negotiated Rate	$65,002.23
Rate for Payer: AlohaCare Medicare	$65,002.23
Rate for Payer: Hawaii Medical Service Association Commercial	$60,890.44
Rate for Payer: Hawaii Medical Service Association Medicare	$65,002.23
Rate for Payer: Humana Medicare	$65,002.23
Rate for Payer: Kaiser Permanente Medicare	$65,002.23
Rate for Payer: Ohana Health Plan Medicare	$65,002.23
Rate for Payer: UnitedHealthcare Medicare	$65,002.23

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$34,984.15

Service Code	MSDRG 575
Min. Negotiated Rate	$18,145.91
Max. Negotiated Rate	$34,984.15
Rate for Payer: AlohaCare Medicare	$18,145.91
Rate for Payer: Hawaii Medical Service Association Commercial	$34,984.15
Rate for Payer: Hawaii Medical Service Association Medicare	$18,145.91
Rate for Payer: Humana Medicare	$18,145.91
Rate for Payer: Kaiser Permanente Medicare	$18,145.91
Rate for Payer: Ohana Health Plan Medicare	$18,145.91
Rate for Payer: UnitedHealthcare Medicare	$18,145.91

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$46,076.69

Service Code	MSDRG 623
Min. Negotiated Rate	$18,115.36
Max. Negotiated Rate	$46,076.69
Rate for Payer: AlohaCare Medicare	$18,115.36
Rate for Payer: Hawaii Medical Service Association Commercial	$46,076.69
Rate for Payer: Hawaii Medical Service Association Medicare	$18,115.36
Rate for Payer: Humana Medicare	$18,115.36
Rate for Payer: Kaiser Permanente Medicare	$18,115.36
Rate for Payer: Ohana Health Plan Medicare	$18,115.36
Rate for Payer: UnitedHealthcare Medicare	$18,115.36

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$46,076.69

Service Code	MSDRG 622
Min. Negotiated Rate	$35,513.02
Max. Negotiated Rate	$46,076.69
Rate for Payer: AlohaCare Medicare	$35,513.02
Rate for Payer: Hawaii Medical Service Association Commercial	$46,076.69
Rate for Payer: Hawaii Medical Service Association Medicare	$35,513.02
Rate for Payer: Humana Medicare	$35,513.02
Rate for Payer: Kaiser Permanente Medicare	$35,513.02
Rate for Payer: Ohana Health Plan Medicare	$35,513.02
Rate for Payer: UnitedHealthcare Medicare	$35,513.02

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$46,076.69

Service Code	MSDRG 624
Min. Negotiated Rate	$12,773.74
Max. Negotiated Rate	$46,076.69
Rate for Payer: AlohaCare Medicare	$12,773.74
Rate for Payer: Hawaii Medical Service Association Commercial	$46,076.69
Rate for Payer: Hawaii Medical Service Association Medicare	$12,773.74
Rate for Payer: Humana Medicare	$12,773.74
Rate for Payer: Kaiser Permanente Medicare	$12,773.74
Rate for Payer: Ohana Health Plan Medicare	$12,773.74
Rate for Payer: UnitedHealthcare Medicare	$12,773.74

SKIN GRAFTS FOR INJURIES WITH CC/MCC

Facility

$65,061.99

Service Code	MSDRG 904
Min. Negotiated Rate	$36,635.54
Max. Negotiated Rate	$65,061.99
Rate for Payer: AlohaCare Medicare	$36,635.54
Rate for Payer: Hawaii Medical Service Association Commercial	$65,061.99
Rate for Payer: Hawaii Medical Service Association Medicare	$36,635.54
Rate for Payer: Humana Medicare	$36,635.54
Rate for Payer: Kaiser Permanente Medicare	$36,635.54
Rate for Payer: Ohana Health Plan Medicare	$36,635.54
Rate for Payer: UnitedHealthcare Medicare	$36,635.54

SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC

Facility

$65,061.99

Service Code	MSDRG 905
Min. Negotiated Rate	$15,055.26
Max. Negotiated Rate	$65,061.99
Rate for Payer: AlohaCare Medicare	$15,055.26
Rate for Payer: Hawaii Medical Service Association Commercial	$65,061.99
Rate for Payer: Hawaii Medical Service Association Medicare	$15,055.26
Rate for Payer: Humana Medicare	$15,055.26
Rate for Payer: Kaiser Permanente Medicare	$15,055.26
Rate for Payer: Ohana Health Plan Medicare	$15,055.26
Rate for Payer: UnitedHealthcare Medicare	$15,055.26

SKIN ULCERS WITH CC

Facility

$23,038.34

Service Code	MSDRG 593
Min. Negotiated Rate	$12,127.24
Max. Negotiated Rate	$23,038.34
Rate for Payer: AlohaCare Medicare	$12,127.24
Rate for Payer: Hawaii Medical Service Association Commercial	$23,038.34
Rate for Payer: Hawaii Medical Service Association Medicare	$12,127.24
Rate for Payer: Humana Medicare	$12,127.24
Rate for Payer: Kaiser Permanente Medicare	$12,127.24
Rate for Payer: Ohana Health Plan Medicare	$12,127.24
Rate for Payer: UnitedHealthcare Medicare	$12,127.24

SKIN ULCERS WITH MCC

Facility

$23,038.34

Service Code	MSDRG 592
Min. Negotiated Rate	$19,508.90
Max. Negotiated Rate	$23,038.34
Rate for Payer: AlohaCare Medicare	$19,508.90
Rate for Payer: Hawaii Medical Service Association Commercial	$23,038.34
Rate for Payer: Hawaii Medical Service Association Medicare	$19,508.90
Rate for Payer: Humana Medicare	$19,508.90
Rate for Payer: Kaiser Permanente Medicare	$19,508.90
Rate for Payer: Ohana Health Plan Medicare	$19,508.90
Rate for Payer: UnitedHealthcare Medicare	$19,508.90

SKIN ULCERS WITHOUT CC/MCC

Facility

$23,038.34

Service Code	MSDRG 594
Min. Negotiated Rate	$8,978.46
Max. Negotiated Rate	$23,038.34
Rate for Payer: AlohaCare Medicare	$8,978.46
Rate for Payer: Hawaii Medical Service Association Commercial	$23,038.34
Rate for Payer: Hawaii Medical Service Association Medicare	$8,978.46
Rate for Payer: Humana Medicare	$8,978.46
Rate for Payer: Kaiser Permanente Medicare	$8,978.46
Rate for Payer: Ohana Health Plan Medicare	$8,978.46
Rate for Payer: UnitedHealthcare Medicare	$8,978.46

SOFT TISSUE PROCEDURES WITH CC

Facility

$46,408.52

Service Code	MSDRG 501
Min. Negotiated Rate	$17,663.97
Max. Negotiated Rate	$46,408.52
Rate for Payer: AlohaCare Medicare	$17,663.97
Rate for Payer: Hawaii Medical Service Association Commercial	$46,408.52
Rate for Payer: Hawaii Medical Service Association Medicare	$17,663.97
Rate for Payer: Humana Medicare	$17,663.97
Rate for Payer: Kaiser Permanente Medicare	$17,663.97
Rate for Payer: Ohana Health Plan Medicare	$17,663.97
Rate for Payer: UnitedHealthcare Medicare	$17,663.97

SOFT TISSUE PROCEDURES WITH MCC

Facility

$46,408.52

Service Code	MSDRG 500
Min. Negotiated Rate	$31,626.06
Max. Negotiated Rate	$46,408.52
Rate for Payer: AlohaCare Medicare	$31,626.06
Rate for Payer: Hawaii Medical Service Association Commercial	$46,408.52
Rate for Payer: Hawaii Medical Service Association Medicare	$31,626.06
Rate for Payer: Humana Medicare	$31,626.06
Rate for Payer: Kaiser Permanente Medicare	$31,626.06
Rate for Payer: Ohana Health Plan Medicare	$31,626.06
Rate for Payer: UnitedHealthcare Medicare	$31,626.06

SOFT TISSUE PROCEDURES WITHOUT CC/MCC

Facility

$22,896.13

Service Code	MSDRG 502
Min. Negotiated Rate	$13,700.16
Max. Negotiated Rate	$22,896.13
Rate for Payer: AlohaCare Medicare	$13,700.16
Rate for Payer: Hawaii Medical Service Association Commercial	$22,896.13
Rate for Payer: Hawaii Medical Service Association Medicare	$13,700.16
Rate for Payer: Humana Medicare	$13,700.16
Rate for Payer: Kaiser Permanente Medicare	$13,700.16
Rate for Payer: Ohana Health Plan Medicare	$13,700.16
Rate for Payer: UnitedHealthcare Medicare	$13,700.16

Speech Lanuage Treatment

Facility

$361.00

Service Code	HCPCS 92507 GN
Hospital Charge Code	ST92507
Hospital Revenue Code	440
Min. Negotiated Rate	$21.05
Max. Negotiated Rate	$350.17
Rate for Payer: AlohaCare Medicaid	$180.50
Rate for Payer: Cash Price	$234.65
Rate for Payer: Cash Price	$234.65
Rate for Payer: Hawaii Western Management Group Commercial	$342.95
Rate for Payer: Health Management Network Commercial	$306.85
Rate for Payer: Kaiser Permanente Commercial	$324.90
Rate for Payer: Kaiser Permanente Medicaid	$184.11
Rate for Payer: MDX Hawaii PPO	$350.17
Rate for Payer: UnitedHealthcare Medicaid	$21.05
Rate for Payer: University Health Alliance Commercial	$263.13

Speech Lanuage Treatment

Facility

$361.00

Service Code	HCPCS 92507 GN
Hospital Charge Code	ST92507
Hospital Revenue Code	440
Min. Negotiated Rate	$306.85
Max. Negotiated Rate	$350.17
Rate for Payer: Cash Price	$234.65
Rate for Payer: Health Management Network Commercial	$306.85
Rate for Payer: Kaiser Permanente Commercial	$324.90
Rate for Payer: MDX Hawaii PPO	$350.17

SPINAL DISORDERS AND INJURIES WITH CC/MCC

Facility

$34,581.22

Service Code	MSDRG 052
Min. Negotiated Rate	$18,286.83
Max. Negotiated Rate	$34,581.22
Rate for Payer: AlohaCare Medicare	$18,286.83
Rate for Payer: Hawaii Medical Service Association Commercial	$34,581.22
Rate for Payer: Hawaii Medical Service Association Medicare	$18,286.83
Rate for Payer: Humana Medicare	$18,286.83
Rate for Payer: Kaiser Permanente Medicare	$18,286.83
Rate for Payer: Ohana Health Plan Medicare	$18,286.83
Rate for Payer: UnitedHealthcare Medicare	$18,286.83

SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC

Facility

$34,581.22

Service Code	MSDRG 053
Min. Negotiated Rate	$10,086.20
Max. Negotiated Rate	$34,581.22
Rate for Payer: AlohaCare Medicare	$10,086.20
Rate for Payer: Hawaii Medical Service Association Commercial	$34,581.22
Rate for Payer: Hawaii Medical Service Association Medicare	$10,086.20
Rate for Payer: Humana Medicare	$10,086.20
Rate for Payer: Kaiser Permanente Medicare	$10,086.20
Rate for Payer: Ohana Health Plan Medicare	$10,086.20
Rate for Payer: UnitedHealthcare Medicare	$10,086.20

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC

Facility

$137,281.98

Service Code	MSDRG 457
Min. Negotiated Rate	$59,204.33
Max. Negotiated Rate	$137,281.98
Rate for Payer: AlohaCare Medicare	$59,204.33
Rate for Payer: Hawaii Medical Service Association Commercial	$137,281.98
Rate for Payer: Hawaii Medical Service Association Medicare	$59,204.33
Rate for Payer: Humana Medicare	$59,204.33
Rate for Payer: Kaiser Permanente Medicare	$59,204.33
Rate for Payer: Ohana Health Plan Medicare	$59,204.33
Rate for Payer: UnitedHealthcare Medicare	$59,204.33

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC

Facility

$137,281.98

Service Code	MSDRG 456
Min. Negotiated Rate	$83,254.36
Max. Negotiated Rate	$137,281.98
Rate for Payer: AlohaCare Medicare	$83,254.36
Rate for Payer: Hawaii Medical Service Association Commercial	$137,281.98
Rate for Payer: Hawaii Medical Service Association Medicare	$83,254.36
Rate for Payer: Humana Medicare	$83,254.36
Rate for Payer: Kaiser Permanente Medicare	$83,254.36
Rate for Payer: Ohana Health Plan Medicare	$83,254.36
Rate for Payer: UnitedHealthcare Medicare	$83,254.36

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC

Facility

$137,281.98

Service Code	MSDRG 458
Min. Negotiated Rate	$41,558.28
Max. Negotiated Rate	$137,281.98
Rate for Payer: AlohaCare Medicare	$41,558.28
Rate for Payer: Hawaii Medical Service Association Commercial	$137,281.98
Rate for Payer: Hawaii Medical Service Association Medicare	$41,558.28
Rate for Payer: Humana Medicare	$41,558.28
Rate for Payer: Kaiser Permanente Medicare	$41,558.28
Rate for Payer: Ohana Health Plan Medicare	$41,558.28
Rate for Payer: UnitedHealthcare Medicare	$41,558.28

SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS

Facility

$71,177.11

Service Code	MSDRG 029
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$71,177.11
Rate for Payer: AlohaCare Medicare	$34,058.37
Rate for Payer: Hawaii Medical Service Association Commercial	$71,177.11
Rate for Payer: Hawaii Medical Service Association Medicare	$34,058.37
Rate for Payer: Humana Medicare	$34,058.37
Rate for Payer: Kaiser Permanente Medicare	$34,058.37
Rate for Payer: Ohana Health Plan Medicare	$34,058.37
Rate for Payer: UnitedHealthcare Medicare	$34,058.37
Rate for Payer: University Health Alliance Commercial	$10,400.00

SPINAL PROCEDURES WITH MCC

Facility

$86,038.26

Service Code	MSDRG 028
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$86,038.26
Rate for Payer: AlohaCare Medicare	$59,649.78
Rate for Payer: Hawaii Medical Service Association Commercial	$86,038.26
Rate for Payer: Hawaii Medical Service Association Medicare	$59,649.78
Rate for Payer: Humana Medicare	$59,649.78
Rate for Payer: Kaiser Permanente Medicare	$59,649.78
Rate for Payer: Ohana Health Plan Medicare	$59,649.78
Rate for Payer: UnitedHealthcare Medicare	$59,649.78
Rate for Payer: University Health Alliance Commercial	$10,400.00

SPINAL PROCEDURES WITHOUT CC/MCC

Facility

$47,190.68

Service Code	MSDRG 030
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$47,190.68
Rate for Payer: AlohaCare Medicare	$22,070.32
Rate for Payer: Hawaii Medical Service Association Commercial	$47,190.68
Rate for Payer: Hawaii Medical Service Association Medicare	$22,070.32
Rate for Payer: Humana Medicare	$22,070.32
Rate for Payer: Kaiser Permanente Medicare	$22,070.32
Rate for Payer: Ohana Health Plan Medicare	$22,070.32
Rate for Payer: UnitedHealthcare Medicare	$22,070.32
Rate for Payer: University Health Alliance Commercial	$10,400.00

SPLENIC PROCEDURES WITH CC

Facility

$43,730.19

Service Code	MSDRG 800
Min. Negotiated Rate	$28,123.48
Max. Negotiated Rate	$43,730.19
Rate for Payer: AlohaCare Medicare	$28,123.48
Rate for Payer: Hawaii Medical Service Association Commercial	$43,730.19
Rate for Payer: Hawaii Medical Service Association Medicare	$28,123.48
Rate for Payer: Humana Medicare	$28,123.48
Rate for Payer: Kaiser Permanente Medicare	$28,123.48
Rate for Payer: Ohana Health Plan Medicare	$28,123.48
Rate for Payer: UnitedHealthcare Medicare	$28,123.48

SPLENIC PROCEDURES WITH MCC

Facility

$45,069.76

Service Code	MSDRG 799
Min. Negotiated Rate	$43,730.19
Max. Negotiated Rate	$45,069.76
Rate for Payer: AlohaCare Medicare	$45,069.76
Rate for Payer: Hawaii Medical Service Association Commercial	$43,730.19
Rate for Payer: Hawaii Medical Service Association Medicare	$45,069.76
Rate for Payer: Humana Medicare	$45,069.76
Rate for Payer: Kaiser Permanente Medicare	$45,069.76
Rate for Payer: Ohana Health Plan Medicare	$45,069.76
Rate for Payer: UnitedHealthcare Medicare	$45,069.76

Know your out-of-pocket cost for care.

All Charges