Leahi Hospital

All Charges

Charge

Type

Setting

Price

TSH

Facility

$356.00

Service Code	HCPCS 84443
Hospital Charge Code	84443
Hospital Revenue Code	301
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$345.32
Rate for Payer: AlohaCare Medicaid	$178.00
Rate for Payer: Cash Price	$231.40
Rate for Payer: Cash Price	$231.40
Rate for Payer: Hawaii Medical Service Association ABD	$23.21
Rate for Payer: Hawaii Medical Service Association Commercial	$21.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.37
Rate for Payer: Hawaii Western Management Group Commercial	$16.80
Rate for Payer: Health Management Network Commercial	$302.60
Rate for Payer: Kaiser Permanente Commercial	$320.40
Rate for Payer: Kaiser Permanente Medicaid	$181.56
Rate for Payer: MDX Hawaii PPO	$345.32
Rate for Payer: UnitedHealthcare Medicaid	$23.21
Rate for Payer: University Health Alliance Commercial	$43.42

TSH

Facility

$356.00

Service Code	HCPCS 84443
Hospital Charge Code	84443
Hospital Revenue Code	301
Min. Negotiated Rate	$302.60
Max. Negotiated Rate	$345.32
Rate for Payer: Cash Price	$231.40
Rate for Payer: Health Management Network Commercial	$302.60
Rate for Payer: Kaiser Permanente Commercial	$320.40
Rate for Payer: MDX Hawaii PPO	$345.32

Tuberculin PPD test

Facility

$98.00

Service Code	HCPCS 86580
Hospital Charge Code	86580
Hospital Revenue Code	302
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$95.06
Rate for Payer: Cash Price	$63.70
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: MDX Hawaii PPO	$95.06

Tuberculin PPD test

Facility

$98.00

Service Code	HCPCS 86580
Hospital Charge Code	86580
Hospital Revenue Code	302
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$95.06
Rate for Payer: AlohaCare Medicaid	$49.00
Rate for Payer: Cash Price	$63.70
Rate for Payer: Cash Price	$63.70
Rate for Payer: Hawaii Medical Service Association ABD	$6.68
Rate for Payer: Hawaii Medical Service Association Commercial	$42.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.23
Rate for Payer: Hawaii Western Management Group Commercial	$34.17
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: Kaiser Permanente Medicaid	$49.98
Rate for Payer: MDX Hawaii PPO	$95.06
Rate for Payer: UnitedHealthcare Medicaid	$6.68
Rate for Payer: University Health Alliance Commercial	$17.04

Tx swallowing dysfunctio

Facility

$487.00

Service Code	HCPCS 92526 GO
Hospital Charge Code	OT92526
Hospital Revenue Code	430
Min. Negotiated Rate	$413.95
Max. Negotiated Rate	$472.39
Rate for Payer: Cash Price	$316.55
Rate for Payer: Health Management Network Commercial	$413.95
Rate for Payer: Kaiser Permanente Commercial	$438.30
Rate for Payer: MDX Hawaii PPO	$472.39

Tx swallowing dysfunctio

Facility

$487.00

Service Code	HCPCS 92526 GO
Hospital Charge Code	OT92526
Hospital Revenue Code	430
Min. Negotiated Rate	$22.46
Max. Negotiated Rate	$472.39
Rate for Payer: AlohaCare Medicaid	$243.50
Rate for Payer: Cash Price	$316.55
Rate for Payer: Cash Price	$316.55
Rate for Payer: Hawaii Western Management Group Commercial	$462.65
Rate for Payer: Health Management Network Commercial	$413.95
Rate for Payer: Kaiser Permanente Commercial	$438.30
Rate for Payer: Kaiser Permanente Medicaid	$248.37
Rate for Payer: MDX Hawaii PPO	$472.39
Rate for Payer: UnitedHealthcare Medicaid	$22.46
Rate for Payer: University Health Alliance Commercial	$354.97

UA complete auto w/micro

Facility

$71.00

Service Code	HCPCS 81001
Hospital Charge Code	81001
Hospital Revenue Code	306
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Hawaii Medical Service Association ABD	$4.37
Rate for Payer: Hawaii Medical Service Association Commercial	$3.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.59
Rate for Payer: Hawaii Western Management Group Commercial	$3.17
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: UnitedHealthcare Medicaid	$4.37
Rate for Payer: University Health Alliance Commercial	$8.20

UA complete auto w/micro

Facility

$71.00

Service Code	HCPCS 81001
Hospital Charge Code	81001
Hospital Revenue Code	306
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

Ultrasound

Facility

$88.00

Service Code	HCPCS 97035 GO
Hospital Charge Code	OT97035
Hospital Revenue Code	430
Min. Negotiated Rate	$9.52
Max. Negotiated Rate	$85.36
Rate for Payer: AlohaCare Medicaid	$44.00
Rate for Payer: Cash Price	$57.20
Rate for Payer: Cash Price	$57.20
Rate for Payer: Hawaii Western Management Group Commercial	$83.60
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Kaiser Permanente Commercial	$79.20
Rate for Payer: Kaiser Permanente Medicaid	$44.88
Rate for Payer: MDX Hawaii PPO	$85.36
Rate for Payer: UnitedHealthcare Medicaid	$9.52
Rate for Payer: University Health Alliance Commercial	$64.14

Ultrasound

Facility

$88.00

Service Code	HCPCS 97035 GO
Hospital Charge Code	OT97035
Hospital Revenue Code	430
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$57.20
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Kaiser Permanente Commercial	$79.20
Rate for Payer: MDX Hawaii PPO	$85.36

Ultrasound 15 min ca

Facility

$88.00

Service Code	HCPCS 97035 GP
Hospital Charge Code	PT97035
Hospital Revenue Code	420
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$57.20
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Kaiser Permanente Commercial	$79.20
Rate for Payer: MDX Hawaii PPO	$85.36

Ultrasound 15 min ca

Facility

$88.00

Service Code	HCPCS 97035 GP
Hospital Charge Code	PT97035
Hospital Revenue Code	420
Min. Negotiated Rate	$9.52
Max. Negotiated Rate	$85.36
Rate for Payer: AlohaCare Medicaid	$44.00
Rate for Payer: Cash Price	$57.20
Rate for Payer: Cash Price	$57.20
Rate for Payer: Hawaii Western Management Group Commercial	$83.60
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Kaiser Permanente Commercial	$79.20
Rate for Payer: Kaiser Permanente Medicaid	$44.88
Rate for Payer: MDX Hawaii PPO	$85.36
Rate for Payer: UnitedHealthcare Medicaid	$9.52
Rate for Payer: University Health Alliance Commercial	$64.14

ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC

Facility

$71,911.87

Service Code	MSDRG 278
Min. Negotiated Rate	$55,292.73
Max. Negotiated Rate	$71,911.87
Rate for Payer: AlohaCare Medicare	$55,292.73
Rate for Payer: Hawaii Medical Service Association Commercial	$71,911.87
Rate for Payer: Hawaii Medical Service Association Medicare	$55,292.73
Rate for Payer: Humana Medicare	$55,292.73
Rate for Payer: Kaiser Permanente Medicare	$55,292.73
Rate for Payer: Ohana Health Plan Medicare	$55,292.73
Rate for Payer: UnitedHealthcare Medicare	$55,292.73

ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC

Facility

$71,911.87

Service Code	MSDRG 279
Min. Negotiated Rate	$35,978.19
Max. Negotiated Rate	$71,911.87
Rate for Payer: AlohaCare Medicare	$35,978.19
Rate for Payer: Hawaii Medical Service Association Commercial	$71,911.87
Rate for Payer: Hawaii Medical Service Association Medicare	$35,978.19
Rate for Payer: Humana Medicare	$35,978.19
Rate for Payer: Kaiser Permanente Medicare	$35,978.19
Rate for Payer: Ohana Health Plan Medicare	$35,978.19
Rate for Payer: UnitedHealthcare Medicare	$35,978.19

ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM

Facility

$29,769.32

Service Code	MSDRG 173
Min. Negotiated Rate	$29,769.32
Max. Negotiated Rate	$29,769.32
Rate for Payer: AlohaCare Medicare	$29,769.32
Rate for Payer: Hawaii Medical Service Association Medicare	$29,769.32
Rate for Payer: Humana Medicare	$29,769.32
Rate for Payer: Kaiser Permanente Medicare	$29,769.32
Rate for Payer: Ohana Health Plan Medicare	$29,769.32
Rate for Payer: UnitedHealthcare Medicare	$29,769.32

UNCOMPLICATED PEPTIC ULCER WITH MCC

Facility

$19,625.26

Service Code	MSDRG 383
Min. Negotiated Rate	$14,043.12
Max. Negotiated Rate	$19,625.26
Rate for Payer: AlohaCare Medicare	$14,043.12
Rate for Payer: Hawaii Medical Service Association Commercial	$19,625.26
Rate for Payer: Hawaii Medical Service Association Medicare	$14,043.12
Rate for Payer: Humana Medicare	$14,043.12
Rate for Payer: Kaiser Permanente Medicare	$14,043.12
Rate for Payer: Ohana Health Plan Medicare	$14,043.12
Rate for Payer: UnitedHealthcare Medicare	$14,043.12

UNCOMPLICATED PEPTIC ULCER WITHOUT MCC

Facility

$19,625.26

Service Code	MSDRG 384
Min. Negotiated Rate	$8,860.17
Max. Negotiated Rate	$19,625.26
Rate for Payer: AlohaCare Medicare	$8,860.17
Rate for Payer: Hawaii Medical Service Association Commercial	$19,625.26
Rate for Payer: Hawaii Medical Service Association Medicare	$8,860.17
Rate for Payer: Humana Medicare	$8,860.17
Rate for Payer: Kaiser Permanente Medicare	$8,860.17
Rate for Payer: Ohana Health Plan Medicare	$8,860.17
Rate for Payer: UnitedHealthcare Medicare	$8,860.17

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC

Facility

$36,643.29

Service Code	MSDRG 256
Min. Negotiated Rate	$17,169.24
Max. Negotiated Rate	$36,643.29
Rate for Payer: AlohaCare Medicare	$17,169.24
Rate for Payer: Hawaii Medical Service Association Commercial	$36,643.29
Rate for Payer: Hawaii Medical Service Association Medicare	$17,169.24
Rate for Payer: Humana Medicare	$17,169.24
Rate for Payer: Kaiser Permanente Medicare	$17,169.24
Rate for Payer: Ohana Health Plan Medicare	$17,169.24
Rate for Payer: UnitedHealthcare Medicare	$17,169.24

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC

Facility

$36,643.29

Service Code	MSDRG 255
Min. Negotiated Rate	$27,019.68
Max. Negotiated Rate	$36,643.29
Rate for Payer: AlohaCare Medicare	$27,019.68
Rate for Payer: Hawaii Medical Service Association Commercial	$36,643.29
Rate for Payer: Hawaii Medical Service Association Medicare	$27,019.68
Rate for Payer: Humana Medicare	$27,019.68
Rate for Payer: Kaiser Permanente Medicare	$27,019.68
Rate for Payer: Ohana Health Plan Medicare	$27,019.68
Rate for Payer: UnitedHealthcare Medicare	$27,019.68

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$36,643.29

Service Code	MSDRG 257
Min. Negotiated Rate	$11,199.85
Max. Negotiated Rate	$36,643.29
Rate for Payer: AlohaCare Medicare	$11,199.85
Rate for Payer: Hawaii Medical Service Association Commercial	$36,643.29
Rate for Payer: Hawaii Medical Service Association Medicare	$11,199.85
Rate for Payer: Humana Medicare	$11,199.85
Rate for Payer: Kaiser Permanente Medicare	$11,199.85
Rate for Payer: Ohana Health Plan Medicare	$11,199.85
Rate for Payer: UnitedHealthcare Medicare	$11,199.85

URETHRAL PROCEDURES WITH CC/MCC

Facility

$35,505.60

Service Code	MSDRG 671
Min. Negotiated Rate	$18,126.20
Max. Negotiated Rate	$35,505.60
Rate for Payer: AlohaCare Medicare	$18,126.20
Rate for Payer: Hawaii Medical Service Association Commercial	$35,505.60
Rate for Payer: Hawaii Medical Service Association Medicare	$18,126.20
Rate for Payer: Humana Medicare	$18,126.20
Rate for Payer: Kaiser Permanente Medicare	$18,126.20
Rate for Payer: Ohana Health Plan Medicare	$18,126.20
Rate for Payer: UnitedHealthcare Medicare	$18,126.20

URETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$35,505.60

Service Code	MSDRG 672
Min. Negotiated Rate	$11,074.69
Max. Negotiated Rate	$35,505.60
Rate for Payer: AlohaCare Medicare	$11,074.69
Rate for Payer: Hawaii Medical Service Association Commercial	$35,505.60
Rate for Payer: Hawaii Medical Service Association Medicare	$11,074.69
Rate for Payer: Humana Medicare	$11,074.69
Rate for Payer: Kaiser Permanente Medicare	$11,074.69
Rate for Payer: Ohana Health Plan Medicare	$11,074.69
Rate for Payer: UnitedHealthcare Medicare	$11,074.69

URETHRAL STRICTURE

Facility

$11,057.93

Service Code	MSDRG 697
Min. Negotiated Rate	$5,190.74
Max. Negotiated Rate	$11,057.93
Rate for Payer: AlohaCare Medicare	$11,057.93
Rate for Payer: Hawaii Medical Service Association Commercial	$5,190.74
Rate for Payer: Hawaii Medical Service Association Medicare	$11,057.93
Rate for Payer: Humana Medicare	$11,057.93
Rate for Payer: Kaiser Permanente Medicare	$11,057.93
Rate for Payer: Ohana Health Plan Medicare	$11,057.93
Rate for Payer: UnitedHealthcare Medicare	$11,057.93

Uric acid

Facility

$96.00

Service Code	HCPCS 84550
Hospital Charge Code	84550
Hospital Revenue Code	301
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$62.40
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12

Uric acid

Facility

$96.00

Service Code	HCPCS 84550
Hospital Charge Code	84550
Hospital Revenue Code	301
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$93.12
Rate for Payer: AlohaCare Medicaid	$48.00
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Hawaii Medical Service Association ABD	$6.25
Rate for Payer: Hawaii Medical Service Association Commercial	$5.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.56
Rate for Payer: Hawaii Western Management Group Commercial	$4.52
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: UnitedHealthcare Medicaid	$6.25
Rate for Payer: University Health Alliance Commercial	$11.67

Know your out-of-pocket cost for care.

All Charges