Leahi Hospital

All Charges

Charge

Type

Setting

Price

Ther-ex for strength & endurance

Facility

$216.00

Service Code	HCPCS 97110 GN
Hospital Charge Code	ST97110
Hospital Revenue Code	440
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

Ther-ex for strength & endurance

Facility

$216.00

Service Code	HCPCS 97110 GN
Hospital Charge Code	ST97110
Hospital Revenue Code	440
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

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC

Facility

$21,047.38

Service Code	MSDRG 626
Min. Negotiated Rate	$15,212.95
Max. Negotiated Rate	$21,047.38
Rate for Payer: AlohaCare Medicare	$15,212.95
Rate for Payer: Hawaii Medical Service Association Commercial	$21,047.38
Rate for Payer: Hawaii Medical Service Association Medicare	$15,212.95
Rate for Payer: Humana Medicare	$15,212.95
Rate for Payer: Kaiser Permanente Medicare	$15,212.95
Rate for Payer: Ohana Health Plan Medicare	$15,212.95
Rate for Payer: UnitedHealthcare Medicare	$15,212.95

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC

Facility

$30,200.00

Service Code	MSDRG 625
Min. Negotiated Rate	$21,047.38
Max. Negotiated Rate	$30,200.00
Rate for Payer: AlohaCare Medicare	$30,200.00
Rate for Payer: Hawaii Medical Service Association Commercial	$21,047.38
Rate for Payer: Hawaii Medical Service Association Medicare	$30,200.00
Rate for Payer: Humana Medicare	$30,200.00
Rate for Payer: Kaiser Permanente Medicare	$30,200.00
Rate for Payer: Ohana Health Plan Medicare	$30,200.00
Rate for Payer: UnitedHealthcare Medicare	$30,200.00

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC

Facility

$21,047.38

Service Code	MSDRG 627
Min. Negotiated Rate	$13,526.69
Max. Negotiated Rate	$21,047.38
Rate for Payer: AlohaCare Medicare	$13,526.69
Rate for Payer: Hawaii Medical Service Association Commercial	$21,047.38
Rate for Payer: Hawaii Medical Service Association Medicare	$13,526.69
Rate for Payer: Humana Medicare	$13,526.69
Rate for Payer: Kaiser Permanente Medicare	$13,526.69
Rate for Payer: Ohana Health Plan Medicare	$13,526.69
Rate for Payer: UnitedHealthcare Medicare	$13,526.69

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC

Facility

$83,122.91

Service Code	MSDRG 012
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$83,122.91
Rate for Payer: AlohaCare Medicare	$41,986.02
Rate for Payer: Hawaii Medical Service Association Commercial	$83,122.91
Rate for Payer: Hawaii Medical Service Association Medicare	$41,986.02
Rate for Payer: Humana Medicare	$41,986.02
Rate for Payer: Kaiser Permanente Medicare	$41,986.02
Rate for Payer: Ohana Health Plan Medicare	$41,986.02
Rate for Payer: UnitedHealthcare Medicare	$41,986.02
Rate for Payer: University Health Alliance Commercial	$10,400.00

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC

Facility

$83,122.91

Service Code	MSDRG 011
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$83,122.91
Rate for Payer: AlohaCare Medicare	$54,187.94
Rate for Payer: Hawaii Medical Service Association Commercial	$83,122.91
Rate for Payer: Hawaii Medical Service Association Medicare	$54,187.94
Rate for Payer: Humana Medicare	$54,187.94
Rate for Payer: Kaiser Permanente Medicare	$54,187.94
Rate for Payer: Ohana Health Plan Medicare	$54,187.94
Rate for Payer: UnitedHealthcare Medicare	$54,187.94
Rate for Payer: University Health Alliance Commercial	$10,400.00

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC

Facility

$83,122.91

Service Code	MSDRG 013
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$83,122.91
Rate for Payer: AlohaCare Medicare	$28,836.99
Rate for Payer: Hawaii Medical Service Association Commercial	$83,122.91
Rate for Payer: Hawaii Medical Service Association Medicare	$28,836.99
Rate for Payer: Humana Medicare	$28,836.99
Rate for Payer: Kaiser Permanente Medicare	$28,836.99
Rate for Payer: Ohana Health Plan Medicare	$28,836.99
Rate for Payer: UnitedHealthcare Medicare	$28,836.99
Rate for Payer: University Health Alliance Commercial	$10,400.00

TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES

Facility

$404,593.14

Service Code	MSDRG 004
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$404,593.14
Rate for Payer: AlohaCare Medicare	$136,946.33
Rate for Payer: Hawaii Medical Service Association Commercial	$404,593.14
Rate for Payer: Hawaii Medical Service Association Medicare	$136,946.33
Rate for Payer: Humana Medicare	$136,946.33
Rate for Payer: Kaiser Permanente Medicare	$136,946.33
Rate for Payer: Ohana Health Plan Medicare	$136,946.33
Rate for Payer: UnitedHealthcare Medicare	$136,946.33
Rate for Payer: University Health Alliance Commercial	$10,400.00

TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC

Facility

$17,468.37

Service Code	MSDRG 069
Min. Negotiated Rate	$8,308.29
Max. Negotiated Rate	$17,468.37
Rate for Payer: AlohaCare Medicare	$8,308.29
Rate for Payer: Hawaii Medical Service Association Commercial	$17,468.37
Rate for Payer: Hawaii Medical Service Association Medicare	$8,308.29
Rate for Payer: Humana Medicare	$8,308.29
Rate for Payer: Kaiser Permanente Medicare	$8,308.29
Rate for Payer: Ohana Health Plan Medicare	$8,308.29
Rate for Payer: UnitedHealthcare Medicare	$8,308.29

TRANSURETHRAL PROCEDURES WITH CC

Facility

$21,165.89

Service Code	MSDRG 669
Min. Negotiated Rate	$15,731.34
Max. Negotiated Rate	$21,165.89
Rate for Payer: AlohaCare Medicare	$15,731.34
Rate for Payer: Hawaii Medical Service Association Commercial	$21,165.89
Rate for Payer: Hawaii Medical Service Association Medicare	$15,731.34
Rate for Payer: Humana Medicare	$15,731.34
Rate for Payer: Kaiser Permanente Medicare	$15,731.34
Rate for Payer: Ohana Health Plan Medicare	$15,731.34
Rate for Payer: UnitedHealthcare Medicare	$15,731.34

TRANSURETHRAL PROCEDURES WITH MCC

Facility

$29,213.48

Service Code	MSDRG 668
Min. Negotiated Rate	$21,165.89
Max. Negotiated Rate	$29,213.48
Rate for Payer: AlohaCare Medicare	$29,213.48
Rate for Payer: Hawaii Medical Service Association Commercial	$21,165.89
Rate for Payer: Hawaii Medical Service Association Medicare	$29,213.48
Rate for Payer: Humana Medicare	$29,213.48
Rate for Payer: Kaiser Permanente Medicare	$29,213.48
Rate for Payer: Ohana Health Plan Medicare	$29,213.48
Rate for Payer: UnitedHealthcare Medicare	$29,213.48

TRANSURETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$18,771.98

Service Code	MSDRG 670
Min. Negotiated Rate	$10,067.47
Max. Negotiated Rate	$18,771.98
Rate for Payer: AlohaCare Medicare	$10,067.47
Rate for Payer: Hawaii Medical Service Association Commercial	$18,771.98
Rate for Payer: Hawaii Medical Service Association Medicare	$10,067.47
Rate for Payer: Humana Medicare	$10,067.47
Rate for Payer: Kaiser Permanente Medicare	$10,067.47
Rate for Payer: Ohana Health Plan Medicare	$10,067.47
Rate for Payer: UnitedHealthcare Medicare	$10,067.47

TRANSURETHRAL PROSTATECTOMY WITH CC/MCC

Facility

$17,681.69

Service Code	MSDRG 713
Min. Negotiated Rate	$15,252.38
Max. Negotiated Rate	$17,681.69
Rate for Payer: AlohaCare Medicare	$15,252.38
Rate for Payer: Hawaii Medical Service Association Commercial	$17,681.69
Rate for Payer: Hawaii Medical Service Association Medicare	$15,252.38
Rate for Payer: Humana Medicare	$15,252.38
Rate for Payer: Kaiser Permanente Medicare	$15,252.38
Rate for Payer: Ohana Health Plan Medicare	$15,252.38
Rate for Payer: UnitedHealthcare Medicare	$15,252.38

TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC

Facility

$14,007.88

Service Code	MSDRG 714
Min. Negotiated Rate	$10,856.88
Max. Negotiated Rate	$14,007.88
Rate for Payer: AlohaCare Medicare	$10,856.88
Rate for Payer: Hawaii Medical Service Association Commercial	$14,007.88
Rate for Payer: Hawaii Medical Service Association Medicare	$10,856.88
Rate for Payer: Humana Medicare	$10,856.88
Rate for Payer: Kaiser Permanente Medicare	$10,856.88
Rate for Payer: Ohana Health Plan Medicare	$10,856.88
Rate for Payer: UnitedHealthcare Medicare	$10,856.88

TRAUMATIC INJURY WITH MCC

Facility

$16,545.39

Service Code	MSDRG 913
Min. Negotiated Rate	$14,861.15
Max. Negotiated Rate	$16,545.39
Rate for Payer: AlohaCare Medicare	$16,545.39
Rate for Payer: Hawaii Medical Service Association Commercial	$14,861.15
Rate for Payer: Hawaii Medical Service Association Medicare	$16,545.39
Rate for Payer: Humana Medicare	$16,545.39
Rate for Payer: Kaiser Permanente Medicare	$16,545.39
Rate for Payer: Ohana Health Plan Medicare	$16,545.39
Rate for Payer: UnitedHealthcare Medicare	$16,545.39

TRAUMATIC INJURY WITHOUT MCC

Facility

$14,861.15

Service Code	MSDRG 914
Min. Negotiated Rate	$9,162.75
Max. Negotiated Rate	$14,861.15
Rate for Payer: AlohaCare Medicare	$9,162.75
Rate for Payer: Hawaii Medical Service Association Commercial	$14,861.15
Rate for Payer: Hawaii Medical Service Association Medicare	$9,162.75
Rate for Payer: Humana Medicare	$9,162.75
Rate for Payer: Kaiser Permanente Medicare	$9,162.75
Rate for Payer: Ohana Health Plan Medicare	$9,162.75
Rate for Payer: UnitedHealthcare Medicare	$9,162.75

TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC

Facility

$16,709.91

Service Code	MSDRG 086
Min. Negotiated Rate	$13,274.40
Max. Negotiated Rate	$16,709.91
Rate for Payer: AlohaCare Medicare	$13,274.40
Rate for Payer: Hawaii Medical Service Association Commercial	$16,709.91
Rate for Payer: Hawaii Medical Service Association Medicare	$13,274.40
Rate for Payer: Humana Medicare	$13,274.40
Rate for Payer: Kaiser Permanente Medicare	$13,274.40
Rate for Payer: Ohana Health Plan Medicare	$13,274.40
Rate for Payer: UnitedHealthcare Medicare	$13,274.40

TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC

Facility

$37,757.29

Service Code	MSDRG 083
Min. Negotiated Rate	$14,191.94
Max. Negotiated Rate	$37,757.29
Rate for Payer: AlohaCare Medicare	$14,191.94
Rate for Payer: Hawaii Medical Service Association Commercial	$37,757.29
Rate for Payer: Hawaii Medical Service Association Medicare	$14,191.94
Rate for Payer: Humana Medicare	$14,191.94
Rate for Payer: Kaiser Permanente Medicare	$14,191.94
Rate for Payer: Ohana Health Plan Medicare	$14,191.94
Rate for Payer: UnitedHealthcare Medicare	$14,191.94

TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC

Facility

$58,235.81

Service Code	MSDRG 085
Min. Negotiated Rate	$22,826.22
Max. Negotiated Rate	$58,235.81
Rate for Payer: AlohaCare Medicare	$22,826.22
Rate for Payer: Hawaii Medical Service Association Commercial	$58,235.81
Rate for Payer: Hawaii Medical Service Association Medicare	$22,826.22
Rate for Payer: Humana Medicare	$22,826.22
Rate for Payer: Kaiser Permanente Medicare	$22,826.22
Rate for Payer: Ohana Health Plan Medicare	$22,826.22
Rate for Payer: UnitedHealthcare Medicare	$22,826.22

TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC

Facility

$37,757.29

Service Code	MSDRG 082
Min. Negotiated Rate	$22,961.24
Max. Negotiated Rate	$37,757.29
Rate for Payer: AlohaCare Medicare	$22,961.24
Rate for Payer: Hawaii Medical Service Association Commercial	$37,757.29
Rate for Payer: Hawaii Medical Service Association Medicare	$22,961.24
Rate for Payer: Humana Medicare	$22,961.24
Rate for Payer: Kaiser Permanente Medicare	$22,961.24
Rate for Payer: Ohana Health Plan Medicare	$22,961.24
Rate for Payer: UnitedHealthcare Medicare	$22,961.24

TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC

Facility

$15,216.68

Service Code	MSDRG 087
Min. Negotiated Rate	$9,450.52
Max. Negotiated Rate	$15,216.68
Rate for Payer: AlohaCare Medicare	$9,450.52
Rate for Payer: Hawaii Medical Service Association Commercial	$15,216.68
Rate for Payer: Hawaii Medical Service Association Medicare	$9,450.52
Rate for Payer: Humana Medicare	$9,450.52
Rate for Payer: Kaiser Permanente Medicare	$9,450.52
Rate for Payer: Ohana Health Plan Medicare	$9,450.52
Rate for Payer: UnitedHealthcare Medicare	$9,450.52

TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC

Facility

$37,757.29

Service Code	MSDRG 084
Min. Negotiated Rate	$9,855.58
Max. Negotiated Rate	$37,757.29
Rate for Payer: AlohaCare Medicare	$9,855.58
Rate for Payer: Hawaii Medical Service Association Commercial	$37,757.29
Rate for Payer: Hawaii Medical Service Association Medicare	$9,855.58
Rate for Payer: Humana Medicare	$9,855.58
Rate for Payer: Kaiser Permanente Medicare	$9,855.58
Rate for Payer: Ohana Health Plan Medicare	$9,855.58
Rate for Payer: UnitedHealthcare Medicare	$9,855.58

TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC

Facility

$17,918.71

Service Code	MSDRG 604
Min. Negotiated Rate	$14,943.89
Max. Negotiated Rate	$17,918.71
Rate for Payer: AlohaCare Medicare	$14,943.89
Rate for Payer: Hawaii Medical Service Association Commercial	$17,918.71
Rate for Payer: Hawaii Medical Service Association Medicare	$14,943.89
Rate for Payer: Humana Medicare	$14,943.89
Rate for Payer: Kaiser Permanente Medicare	$14,943.89
Rate for Payer: Ohana Health Plan Medicare	$14,943.89
Rate for Payer: UnitedHealthcare Medicare	$14,943.89

TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC

Facility

$14,718.94

Service Code	MSDRG 605
Min. Negotiated Rate	$9,463.33
Max. Negotiated Rate	$14,718.94
Rate for Payer: AlohaCare Medicare	$9,463.33
Rate for Payer: Hawaii Medical Service Association Commercial	$14,718.94
Rate for Payer: Hawaii Medical Service Association Medicare	$9,463.33
Rate for Payer: Humana Medicare	$9,463.33
Rate for Payer: Kaiser Permanente Medicare	$9,463.33
Rate for Payer: Ohana Health Plan Medicare	$9,463.33
Rate for Payer: UnitedHealthcare Medicare	$9,463.33

Know your out-of-pocket cost for care.

All Charges