Leahi Hospital

All Charges

Charge

Type

Setting

Price

SPLENIC PROCEDURES WITHOUT CC/MCC

Facility

$43,730.19

Service Code	MSDRG 801
Min. Negotiated Rate	$19,248.72
Max. Negotiated Rate	$43,730.19
Rate for Payer: AlohaCare Medicare	$19,248.72
Rate for Payer: Hawaii Medical Service Association Commercial	$43,730.19
Rate for Payer: Hawaii Medical Service Association Medicare	$19,248.72
Rate for Payer: Humana Medicare	$19,248.72
Rate for Payer: Kaiser Permanente Medicare	$19,248.72
Rate for Payer: Ohana Health Plan Medicare	$19,248.72
Rate for Payer: UnitedHealthcare Medicare	$19,248.72

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC

Facility

$24,910.80

Service Code	MSDRG 537
Min. Negotiated Rate	$9,840.81
Max. Negotiated Rate	$24,910.80
Rate for Payer: AlohaCare Medicare	$9,840.81
Rate for Payer: Hawaii Medical Service Association Commercial	$24,910.80
Rate for Payer: Hawaii Medical Service Association Medicare	$9,840.81
Rate for Payer: Humana Medicare	$9,840.81
Rate for Payer: Kaiser Permanente Medicare	$9,840.81
Rate for Payer: Ohana Health Plan Medicare	$9,840.81
Rate for Payer: UnitedHealthcare Medicare	$9,840.81

SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC

Facility

$24,910.80

Service Code	MSDRG 538
Min. Negotiated Rate	$7,534.64
Max. Negotiated Rate	$24,910.80
Rate for Payer: AlohaCare Medicare	$7,534.64
Rate for Payer: Hawaii Medical Service Association Commercial	$24,910.80
Rate for Payer: Hawaii Medical Service Association Medicare	$7,534.64
Rate for Payer: Humana Medicare	$7,534.64
Rate for Payer: Kaiser Permanente Medicare	$7,534.64
Rate for Payer: Ohana Health Plan Medicare	$7,534.64
Rate for Payer: UnitedHealthcare Medicare	$7,534.64

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC

Facility

$89,640.96

Service Code	MSDRG 327
Min. Negotiated Rate	$24,524.29
Max. Negotiated Rate	$89,640.96
Rate for Payer: AlohaCare Medicare	$24,524.29
Rate for Payer: Hawaii Medical Service Association Commercial	$89,640.96
Rate for Payer: Hawaii Medical Service Association Medicare	$24,524.29
Rate for Payer: Humana Medicare	$24,524.29
Rate for Payer: Kaiser Permanente Medicare	$24,524.29
Rate for Payer: Ohana Health Plan Medicare	$24,524.29
Rate for Payer: UnitedHealthcare Medicare	$24,524.29

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC

Facility

$126,639.79

Service Code	MSDRG 326
Min. Negotiated Rate	$49,588.45
Max. Negotiated Rate	$126,639.79
Rate for Payer: AlohaCare Medicare	$49,588.45
Rate for Payer: Hawaii Medical Service Association Commercial	$126,639.79
Rate for Payer: Hawaii Medical Service Association Medicare	$49,588.45
Rate for Payer: Humana Medicare	$49,588.45
Rate for Payer: Kaiser Permanente Medicare	$49,588.45
Rate for Payer: Ohana Health Plan Medicare	$49,588.45
Rate for Payer: UnitedHealthcare Medicare	$49,588.45

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC

Facility

$38,373.54

Service Code	MSDRG 328
Min. Negotiated Rate	$16,227.07
Max. Negotiated Rate	$38,373.54
Rate for Payer: AlohaCare Medicare	$16,227.07
Rate for Payer: Hawaii Medical Service Association Commercial	$38,373.54
Rate for Payer: Hawaii Medical Service Association Medicare	$16,227.07
Rate for Payer: Humana Medicare	$16,227.07
Rate for Payer: Kaiser Permanente Medicare	$16,227.07
Rate for Payer: Ohana Health Plan Medicare	$16,227.07
Rate for Payer: UnitedHealthcare Medicare	$16,227.07

Swallow Eval

Facility

$1,000.00

Service Code	HCPCS 92610 GN
Hospital Charge Code	ST92610
Hospital Revenue Code	444
Min. Negotiated Rate	$88.36
Max. Negotiated Rate	$970.00
Rate for Payer: AlohaCare Medicaid	$500.00
Rate for Payer: Cash Price	$650.00
Rate for Payer: Cash Price	$650.00
Rate for Payer: Hawaii Western Management Group Commercial	$950.00
Rate for Payer: Health Management Network Commercial	$850.00
Rate for Payer: Kaiser Permanente Commercial	$900.00
Rate for Payer: Kaiser Permanente Medicaid	$510.00
Rate for Payer: MDX Hawaii PPO	$970.00
Rate for Payer: UnitedHealthcare Medicaid	$88.36
Rate for Payer: University Health Alliance Commercial	$728.90

Swallow Eval

Facility

$1,000.00

Service Code	HCPCS 92610 GN
Hospital Charge Code	ST92610
Hospital Revenue Code	444
Min. Negotiated Rate	$850.00
Max. Negotiated Rate	$970.00
Rate for Payer: Cash Price	$650.00
Rate for Payer: Health Management Network Commercial	$850.00
Rate for Payer: Kaiser Permanente Commercial	$900.00
Rate for Payer: MDX Hawaii PPO	$970.00

SYNCOPE AND COLLAPSE

Facility

$14,007.88

Service Code	MSDRG 312
Min. Negotiated Rate	$9,025.76
Max. Negotiated Rate	$14,007.88
Rate for Payer: AlohaCare Medicare	$9,025.76
Rate for Payer: Hawaii Medical Service Association Commercial	$14,007.88
Rate for Payer: Hawaii Medical Service Association Medicare	$9,025.76
Rate for Payer: Humana Medicare	$9,025.76
Rate for Payer: Kaiser Permanente Medicare	$9,025.76
Rate for Payer: Ohana Health Plan Medicare	$9,025.76
Rate for Payer: UnitedHealthcare Medicare	$9,025.76

T4 free

Facility

$173.00

Service Code	HCPCS 84439
Hospital Charge Code	84439
Hospital Revenue Code	301
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$167.81
Rate for Payer: AlohaCare Medicaid	$86.50
Rate for Payer: Cash Price	$112.45
Rate for Payer: Cash Price	$112.45
Rate for Payer: Hawaii Medical Service Association ABD	$12.46
Rate for Payer: Hawaii Medical Service Association Commercial	$11.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.08
Rate for Payer: Hawaii Western Management Group Commercial	$9.02
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: Kaiser Permanente Medicaid	$88.23
Rate for Payer: MDX Hawaii PPO	$167.81
Rate for Payer: UnitedHealthcare Medicaid	$12.46
Rate for Payer: University Health Alliance Commercial	$23.31

T4 free

Facility

$173.00

Service Code	HCPCS 84439
Hospital Charge Code	84439
Hospital Revenue Code	301
Min. Negotiated Rate	$147.05
Max. Negotiated Rate	$167.81
Rate for Payer: Cash Price	$112.45
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: MDX Hawaii PPO	$167.81

Tacrolimus Fk506

Facility

$234.00

Service Code	HCPCS 80197
Hospital Charge Code	80197
Hospital Revenue Code	301
Min. Negotiated Rate	$198.90
Max. Negotiated Rate	$226.98
Rate for Payer: Cash Price	$152.10
Rate for Payer: Health Management Network Commercial	$198.90
Rate for Payer: Kaiser Permanente Commercial	$210.60
Rate for Payer: MDX Hawaii PPO	$226.98

Tacrolimus Fk506

Facility

$234.00

Service Code	HCPCS 80197
Hospital Charge Code	80197
Hospital Revenue Code	301
Min. Negotiated Rate	$13.73
Max. Negotiated Rate	$226.98
Rate for Payer: AlohaCare Medicaid	$117.00
Rate for Payer: Cash Price	$152.10
Rate for Payer: Cash Price	$152.10
Rate for Payer: Hawaii Medical Service Association ABD	$18.97
Rate for Payer: Hawaii Medical Service Association Commercial	$17.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.92
Rate for Payer: Hawaii Western Management Group Commercial	$13.73
Rate for Payer: Health Management Network Commercial	$198.90
Rate for Payer: Kaiser Permanente Commercial	$210.60
Rate for Payer: Kaiser Permanente Medicaid	$119.34
Rate for Payer: MDX Hawaii PPO	$226.98
Rate for Payer: UnitedHealthcare Medicaid	$18.97
Rate for Payer: University Health Alliance Commercial	$35.46

TENDONITIS, MYOSITIS AND BURSITIS WITH MCC

Facility

$19,767.47

Service Code	MSDRG 557
Min. Negotiated Rate	$15,089.75
Max. Negotiated Rate	$19,767.47
Rate for Payer: AlohaCare Medicare	$15,089.75
Rate for Payer: Hawaii Medical Service Association Commercial	$19,767.47
Rate for Payer: Hawaii Medical Service Association Medicare	$15,089.75
Rate for Payer: Humana Medicare	$15,089.75
Rate for Payer: Kaiser Permanente Medicare	$15,089.75
Rate for Payer: Ohana Health Plan Medicare	$15,089.75
Rate for Payer: UnitedHealthcare Medicare	$15,089.75

TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC

Facility

$19,767.47

Service Code	MSDRG 558
Min. Negotiated Rate	$9,238.63
Max. Negotiated Rate	$19,767.47
Rate for Payer: AlohaCare Medicare	$9,238.63
Rate for Payer: Hawaii Medical Service Association Commercial	$19,767.47
Rate for Payer: Hawaii Medical Service Association Medicare	$9,238.63
Rate for Payer: Humana Medicare	$9,238.63
Rate for Payer: Kaiser Permanente Medicare	$9,238.63
Rate for Payer: Ohana Health Plan Medicare	$9,238.63
Rate for Payer: UnitedHealthcare Medicare	$9,238.63

TESTES PROCEDURES WITH CC/MCC

Facility

$51,883.68

Service Code	MSDRG 711
Min. Negotiated Rate	$20,972.42
Max. Negotiated Rate	$51,883.68
Rate for Payer: AlohaCare Medicare	$20,972.42
Rate for Payer: Hawaii Medical Service Association Commercial	$51,883.68
Rate for Payer: Hawaii Medical Service Association Medicare	$20,972.42
Rate for Payer: Humana Medicare	$20,972.42
Rate for Payer: Kaiser Permanente Medicare	$20,972.42
Rate for Payer: Ohana Health Plan Medicare	$20,972.42
Rate for Payer: UnitedHealthcare Medicare	$20,972.42

TESTES PROCEDURES WITHOUT CC/MCC

Facility

$36,714.40

Service Code	MSDRG 712
Min. Negotiated Rate	$11,273.77
Max. Negotiated Rate	$36,714.40
Rate for Payer: AlohaCare Medicare	$11,273.77
Rate for Payer: Hawaii Medical Service Association Commercial	$36,714.40
Rate for Payer: Hawaii Medical Service Association Medicare	$11,273.77
Rate for Payer: Humana Medicare	$11,273.77
Rate for Payer: Kaiser Permanente Medicare	$11,273.77
Rate for Payer: Ohana Health Plan Medicare	$11,273.77
Rate for Payer: UnitedHealthcare Medicare	$11,273.77

Therapeutic Activities

Facility

$246.00

Service Code	HCPCS 97530 GP
Hospital Charge Code	PT97530
Hospital Revenue Code	420
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$238.62
Rate for Payer: AlohaCare Medicaid	$123.00
Rate for Payer: Cash Price	$159.90
Rate for Payer: Cash Price	$159.90
Rate for Payer: Hawaii Western Management Group Commercial	$233.70
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Kaiser Permanente Commercial	$221.40
Rate for Payer: Kaiser Permanente Medicaid	$125.46
Rate for Payer: MDX Hawaii PPO	$238.62
Rate for Payer: UnitedHealthcare Medicaid	$18.32
Rate for Payer: University Health Alliance Commercial	$179.31

Therapeutic Activities

Facility

$246.00

Service Code	HCPCS 97530 GP
Hospital Charge Code	PT97530
Hospital Revenue Code	420
Min. Negotiated Rate	$209.10
Max. Negotiated Rate	$238.62
Rate for Payer: Cash Price	$159.90
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Kaiser Permanente Commercial	$221.40
Rate for Payer: MDX Hawaii PPO	$238.62

Therapeutic Activities

Facility

$246.00

Service Code	HCPCS 97530 GO
Hospital Charge Code	OT97530
Hospital Revenue Code	430
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$238.62
Rate for Payer: AlohaCare Medicaid	$123.00
Rate for Payer: Cash Price	$159.90
Rate for Payer: Cash Price	$159.90
Rate for Payer: Hawaii Western Management Group Commercial	$233.70
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Kaiser Permanente Commercial	$221.40
Rate for Payer: Kaiser Permanente Medicaid	$125.46
Rate for Payer: MDX Hawaii PPO	$238.62
Rate for Payer: UnitedHealthcare Medicaid	$18.32
Rate for Payer: University Health Alliance Commercial	$179.31

Therapeutic Activities

Facility

$246.00

Service Code	HCPCS 97530 GO
Hospital Charge Code	OT97530
Hospital Revenue Code	430
Min. Negotiated Rate	$209.10
Max. Negotiated Rate	$238.62
Rate for Payer: Cash Price	$159.90
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Kaiser Permanente Commercial	$221.40
Rate for Payer: MDX Hawaii PPO	$238.62

Therapeutic Exercise

Facility

$216.00

Service Code	HCPCS 97110 GO
Hospital Charge Code	OT97110
Hospital Revenue Code	430
Min. Negotiated Rate	$17.65
Max. Negotiated Rate	$209.52
Rate for Payer: AlohaCare Medicaid	$108.00
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Hawaii Western Management Group Commercial	$205.20
Rate for Payer: Health Management Network Commercial	$183.60
Rate for Payer: Kaiser Permanente Commercial	$194.40
Rate for Payer: Kaiser Permanente Medicaid	$110.16
Rate for Payer: MDX Hawaii PPO	$209.52
Rate for Payer: UnitedHealthcare Medicaid	$17.65
Rate for Payer: University Health Alliance Commercial	$157.44

Therapeutic Exercise

Facility

$216.00

Service Code	HCPCS 97110 GP
Hospital Charge Code	PT97110
Hospital Revenue Code	420
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$209.52
Rate for Payer: Cash Price	$140.40
Rate for Payer: Health Management Network Commercial	$183.60
Rate for Payer: Kaiser Permanente Commercial	$194.40
Rate for Payer: MDX Hawaii PPO	$209.52

Therapeutic Exercise

Facility

$216.00

Service Code	HCPCS 97110 GO
Hospital Charge Code	OT97110
Hospital Revenue Code	430
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$209.52
Rate for Payer: Cash Price	$140.40
Rate for Payer: Health Management Network Commercial	$183.60
Rate for Payer: Kaiser Permanente Commercial	$194.40
Rate for Payer: MDX Hawaii PPO	$209.52

Therapeutic Exercise

Facility

$216.00

Service Code	HCPCS 97110 GP
Hospital Charge Code	PT97110
Hospital Revenue Code	420
Min. Negotiated Rate	$17.65
Max. Negotiated Rate	$209.52
Rate for Payer: AlohaCare Medicaid	$108.00
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Hawaii Western Management Group Commercial	$205.20
Rate for Payer: Health Management Network Commercial	$183.60
Rate for Payer: Kaiser Permanente Commercial	$194.40
Rate for Payer: Kaiser Permanente Medicaid	$110.16
Rate for Payer: MDX Hawaii PPO	$209.52
Rate for Payer: UnitedHealthcare Medicaid	$17.65
Rate for Payer: University Health Alliance Commercial	$157.44

Know your out-of-pocket cost for care.

All Charges