Leahi Hospital

All Charges

Charge

Type

Setting

Price

URINARY STONES WITH MCC

Facility

$13,686.35

Service Code	MSDRG 693
Min. Negotiated Rate	$12,538.36
Max. Negotiated Rate	$13,686.35
Rate for Payer: AlohaCare Medicare	$13,686.35
Rate for Payer: Hawaii Medical Service Association Commercial	$12,538.36
Rate for Payer: Hawaii Medical Service Association Medicare	$13,686.35
Rate for Payer: Humana Medicare	$13,686.35
Rate for Payer: Kaiser Permanente Medicare	$13,686.35
Rate for Payer: Ohana Health Plan Medicare	$13,686.35
Rate for Payer: UnitedHealthcare Medicare	$13,686.35

URINARY STONES WITHOUT MCC

Facility

$11,708.79

Service Code	MSDRG 694
Min. Negotiated Rate	$8,139.76
Max. Negotiated Rate	$11,708.79
Rate for Payer: AlohaCare Medicare	$8,139.76
Rate for Payer: Hawaii Medical Service Association Commercial	$11,708.79
Rate for Payer: Hawaii Medical Service Association Medicare	$8,139.76
Rate for Payer: Humana Medicare	$8,139.76
Rate for Payer: Kaiser Permanente Medicare	$8,139.76
Rate for Payer: Ohana Health Plan Medicare	$8,139.76
Rate for Payer: UnitedHealthcare Medicare	$8,139.76

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC

Facility

$22,279.88

Service Code	MSDRG 742
Min. Negotiated Rate	$18,518.44
Max. Negotiated Rate	$22,279.88
Rate for Payer: AlohaCare Medicare	$18,518.44
Rate for Payer: Hawaii Medical Service Association Commercial	$22,279.88
Rate for Payer: Hawaii Medical Service Association Medicare	$18,518.44
Rate for Payer: Humana Medicare	$18,518.44
Rate for Payer: Kaiser Permanente Medicare	$18,518.44
Rate for Payer: Ohana Health Plan Medicare	$18,518.44
Rate for Payer: UnitedHealthcare Medicare	$18,518.44

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC

Facility

$20,028.19

Service Code	MSDRG 743
Min. Negotiated Rate	$12,663.37
Max. Negotiated Rate	$20,028.19
Rate for Payer: AlohaCare Medicare	$12,663.37
Rate for Payer: Hawaii Medical Service Association Commercial	$20,028.19
Rate for Payer: Hawaii Medical Service Association Medicare	$12,663.37
Rate for Payer: Humana Medicare	$12,663.37
Rate for Payer: Kaiser Permanente Medicare	$12,663.37
Rate for Payer: Ohana Health Plan Medicare	$12,663.37
Rate for Payer: UnitedHealthcare Medicare	$12,663.37

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC

Facility

$36,074.44

Service Code	MSDRG 740
Min. Negotiated Rate	$18,270.09
Max. Negotiated Rate	$36,074.44
Rate for Payer: AlohaCare Medicare	$18,270.09
Rate for Payer: Hawaii Medical Service Association Commercial	$36,074.44
Rate for Payer: Hawaii Medical Service Association Medicare	$18,270.09
Rate for Payer: Humana Medicare	$18,270.09
Rate for Payer: Kaiser Permanente Medicare	$18,270.09
Rate for Payer: Ohana Health Plan Medicare	$18,270.09
Rate for Payer: UnitedHealthcare Medicare	$18,270.09

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC

Facility

$37,496.56

Service Code	MSDRG 739
Min. Negotiated Rate	$35,745.61
Max. Negotiated Rate	$37,496.56
Rate for Payer: AlohaCare Medicare	$35,745.61
Rate for Payer: Hawaii Medical Service Association Commercial	$37,496.56
Rate for Payer: Hawaii Medical Service Association Medicare	$35,745.61
Rate for Payer: Humana Medicare	$35,745.61
Rate for Payer: Kaiser Permanente Medicare	$35,745.61
Rate for Payer: Ohana Health Plan Medicare	$35,745.61
Rate for Payer: UnitedHealthcare Medicare	$35,745.61

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$25,835.18

Service Code	MSDRG 741
Min. Negotiated Rate	$14,490.56
Max. Negotiated Rate	$25,835.18
Rate for Payer: AlohaCare Medicare	$14,490.56
Rate for Payer: Hawaii Medical Service Association Commercial	$25,835.18
Rate for Payer: Hawaii Medical Service Association Medicare	$14,490.56
Rate for Payer: Humana Medicare	$14,490.56
Rate for Payer: Kaiser Permanente Medicare	$14,490.56
Rate for Payer: Ohana Health Plan Medicare	$14,490.56
Rate for Payer: UnitedHealthcare Medicare	$14,490.56

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC

Facility

$45,626.35

Service Code	MSDRG 737
Min. Negotiated Rate	$20,743.77
Max. Negotiated Rate	$45,626.35
Rate for Payer: AlohaCare Medicare	$20,743.77
Rate for Payer: Hawaii Medical Service Association Commercial	$45,626.35
Rate for Payer: Hawaii Medical Service Association Medicare	$20,743.77
Rate for Payer: Humana Medicare	$20,743.77
Rate for Payer: Kaiser Permanente Medicare	$20,743.77
Rate for Payer: Ohana Health Plan Medicare	$20,743.77
Rate for Payer: UnitedHealthcare Medicare	$20,743.77

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC

Facility

$45,626.35

Service Code	MSDRG 736
Min. Negotiated Rate	$35,663.81
Max. Negotiated Rate	$45,626.35
Rate for Payer: AlohaCare Medicare	$35,663.81
Rate for Payer: Hawaii Medical Service Association Commercial	$45,626.35
Rate for Payer: Hawaii Medical Service Association Medicare	$35,663.81
Rate for Payer: Humana Medicare	$35,663.81
Rate for Payer: Kaiser Permanente Medicare	$35,663.81
Rate for Payer: Ohana Health Plan Medicare	$35,663.81
Rate for Payer: UnitedHealthcare Medicare	$35,663.81

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$45,626.35

Service Code	MSDRG 738
Min. Negotiated Rate	$14,908.42
Max. Negotiated Rate	$45,626.35
Rate for Payer: AlohaCare Medicare	$14,908.42
Rate for Payer: Hawaii Medical Service Association Commercial	$45,626.35
Rate for Payer: Hawaii Medical Service Association Medicare	$14,908.42
Rate for Payer: Humana Medicare	$14,908.42
Rate for Payer: Kaiser Permanente Medicare	$14,908.42
Rate for Payer: Ohana Health Plan Medicare	$14,908.42
Rate for Payer: UnitedHealthcare Medicare	$14,908.42

Vaccine Administration Flu

Facility

$163.00

Service Code	HCPCS G0008
Hospital Charge Code	VAC ADMIN-F
Hospital Revenue Code	771
Min. Negotiated Rate	$138.55
Max. Negotiated Rate	$158.11
Rate for Payer: Cash Price	$105.95
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Kaiser Permanente Commercial	$146.70
Rate for Payer: MDX Hawaii PPO	$158.11

Vaccine Administration Flu

Facility

$163.00

Service Code	HCPCS G0008
Hospital Charge Code	VAC ADMIN-F
Hospital Revenue Code	771
Min. Negotiated Rate	$34.61
Max. Negotiated Rate	$158.11
Rate for Payer: AlohaCare Medicaid	$81.50
Rate for Payer: Cash Price	$105.95
Rate for Payer: Cash Price	$105.95
Rate for Payer: Hawaii Medical Service Association Commercial	$69.15
Rate for Payer: Hawaii Western Management Group Commercial	$154.85
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Kaiser Permanente Commercial	$146.70
Rate for Payer: Kaiser Permanente Medicaid	$83.13
Rate for Payer: MDX Hawaii PPO	$158.11
Rate for Payer: UnitedHealthcare Medicaid	$34.61
Rate for Payer: University Health Alliance Commercial	$118.81

Vaccine Administration Pneumovac

Facility

$163.00

Service Code	HCPCS G0009
Hospital Charge Code	VAC ADMIN-P
Hospital Revenue Code	771
Min. Negotiated Rate	$138.55
Max. Negotiated Rate	$158.11
Rate for Payer: Cash Price	$105.95
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Kaiser Permanente Commercial	$146.70
Rate for Payer: MDX Hawaii PPO	$158.11

Vaccine Administration Pneumovac

Facility

$163.00

Service Code	HCPCS G0009
Hospital Charge Code	VAC ADMIN-P
Hospital Revenue Code	771
Min. Negotiated Rate	$34.61
Max. Negotiated Rate	$158.11
Rate for Payer: AlohaCare Medicaid	$81.50
Rate for Payer: Cash Price	$105.95
Rate for Payer: Cash Price	$105.95
Rate for Payer: Hawaii Medical Service Association Commercial	$69.15
Rate for Payer: Hawaii Western Management Group Commercial	$154.85
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Kaiser Permanente Commercial	$146.70
Rate for Payer: Kaiser Permanente Medicaid	$83.13
Rate for Payer: MDX Hawaii PPO	$158.11
Rate for Payer: UnitedHealthcare Medicaid	$34.61
Rate for Payer: University Health Alliance Commercial	$118.81

VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC

Facility

$26,451.43

Service Code	MSDRG 746
Min. Negotiated Rate	$17,555.56
Max. Negotiated Rate	$26,451.43
Rate for Payer: AlohaCare Medicare	$17,555.56
Rate for Payer: Hawaii Medical Service Association Commercial	$26,451.43
Rate for Payer: Hawaii Medical Service Association Medicare	$17,555.56
Rate for Payer: Humana Medicare	$17,555.56
Rate for Payer: Kaiser Permanente Medicare	$17,555.56
Rate for Payer: Ohana Health Plan Medicare	$17,555.56
Rate for Payer: UnitedHealthcare Medicare	$17,555.56

VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC

Facility

$26,451.43

Service Code	MSDRG 747
Min. Negotiated Rate	$8,908.47
Max. Negotiated Rate	$26,451.43
Rate for Payer: AlohaCare Medicare	$8,908.47
Rate for Payer: Hawaii Medical Service Association Commercial	$26,451.43
Rate for Payer: Hawaii Medical Service Association Medicare	$8,908.47
Rate for Payer: Humana Medicare	$8,908.47
Rate for Payer: Kaiser Permanente Medicare	$8,908.47
Rate for Payer: Ohana Health Plan Medicare	$8,908.47
Rate for Payer: UnitedHealthcare Medicare	$8,908.47

VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C

Facility

$12,490.95

Service Code	MSDRG 768
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$12,490.95
Rate for Payer: AlohaCare Medicare	$10,996.83
Rate for Payer: Hawaii Medical Service Association Commercial	$12,490.95
Rate for Payer: Hawaii Medical Service Association Medicare	$10,996.83
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: Humana Medicare	$10,996.83
Rate for Payer: Kaiser Permanente Medicare	$10,996.83
Rate for Payer: Ohana Health Plan Medicare	$10,996.83
Rate for Payer: UnitedHealthcare Medicare	$10,996.83
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC

Facility

$10,120.75

Service Code	MSDRG 806
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$10,120.75
Rate for Payer: AlohaCare Medicare	$7,866.77
Rate for Payer: Hawaii Medical Service Association Commercial	$10,120.75
Rate for Payer: Hawaii Medical Service Association Medicare	$7,866.77
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: Humana Medicare	$7,866.77
Rate for Payer: Kaiser Permanente Medicare	$7,866.77
Rate for Payer: Ohana Health Plan Medicare	$7,866.77
Rate for Payer: UnitedHealthcare Medicare	$7,866.77
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC

Facility

$11,071.73

Service Code	MSDRG 805
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$11,071.73
Rate for Payer: AlohaCare Medicare	$11,071.73
Rate for Payer: Hawaii Medical Service Association Commercial	$10,120.75
Rate for Payer: Hawaii Medical Service Association Medicare	$11,071.73
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: Humana Medicare	$11,071.73
Rate for Payer: Kaiser Permanente Medicare	$11,071.73
Rate for Payer: Ohana Health Plan Medicare	$11,071.73
Rate for Payer: UnitedHealthcare Medicare	$11,071.73
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC

Facility

$9,125.27

Service Code	MSDRG 807
Min. Negotiated Rate	$7,080.31
Max. Negotiated Rate	$9,125.27
Rate for Payer: AlohaCare Medicare	$7,080.31
Rate for Payer: Hawaii Medical Service Association Commercial	$9,125.27
Rate for Payer: Hawaii Medical Service Association Medicare	$7,080.31
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: Humana Medicare	$7,080.31
Rate for Payer: Kaiser Permanente Medicare	$7,080.31
Rate for Payer: Ohana Health Plan Medicare	$7,080.31
Rate for Payer: UnitedHealthcare Medicare	$7,080.31
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC

Facility

$14,695.24

Service Code	MSDRG 797
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$14,695.24
Rate for Payer: AlohaCare Medicare	$10,295.12
Rate for Payer: Hawaii Medical Service Association Commercial	$14,695.24
Rate for Payer: Hawaii Medical Service Association Medicare	$10,295.12
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: Humana Medicare	$10,295.12
Rate for Payer: Kaiser Permanente Medicare	$10,295.12
Rate for Payer: Ohana Health Plan Medicare	$10,295.12
Rate for Payer: UnitedHealthcare Medicare	$10,295.12
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC

Facility

$14,695.24

Service Code	MSDRG 796
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$14,695.24
Rate for Payer: AlohaCare Medicare	$11,937.03
Rate for Payer: Hawaii Medical Service Association Commercial	$14,695.24
Rate for Payer: Hawaii Medical Service Association Medicare	$11,937.03
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: Humana Medicare	$11,937.03
Rate for Payer: Kaiser Permanente Medicare	$11,937.03
Rate for Payer: Ohana Health Plan Medicare	$11,937.03
Rate for Payer: UnitedHealthcare Medicare	$11,937.03
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC

Facility

$14,695.24

Service Code	MSDRG 798
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$14,695.24
Rate for Payer: AlohaCare Medicare	$9,868.38
Rate for Payer: Hawaii Medical Service Association Commercial	$14,695.24
Rate for Payer: Hawaii Medical Service Association Medicare	$9,868.38
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: Humana Medicare	$9,868.38
Rate for Payer: Kaiser Permanente Medicare	$9,868.38
Rate for Payer: Ohana Health Plan Medicare	$9,868.38
Rate for Payer: UnitedHealthcare Medicare	$9,868.38
Rate for Payer: University Health Alliance Commercial	$7,760.00

Vancomycin trough

Facility

$244.00

Service Code	HCPCS 80202
Hospital Charge Code	80202
Hospital Revenue Code	301
Min. Negotiated Rate	$13.54
Max. Negotiated Rate	$236.68
Rate for Payer: AlohaCare Medicaid	$122.00
Rate for Payer: Cash Price	$158.60
Rate for Payer: Cash Price	$158.60
Rate for Payer: Hawaii Medical Service Association ABD	$18.72
Rate for Payer: Hawaii Medical Service Association Commercial	$16.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.66
Rate for Payer: Hawaii Western Management Group Commercial	$13.54
Rate for Payer: Health Management Network Commercial	$207.40
Rate for Payer: Kaiser Permanente Commercial	$219.60
Rate for Payer: Kaiser Permanente Medicaid	$124.44
Rate for Payer: MDX Hawaii PPO	$236.68
Rate for Payer: UnitedHealthcare Medicaid	$18.72
Rate for Payer: University Health Alliance Commercial	$35.02

Vancomycin trough

Facility

$244.00

Service Code	HCPCS 80202
Hospital Charge Code	80202
Hospital Revenue Code	301
Min. Negotiated Rate	$207.40
Max. Negotiated Rate	$236.68
Rate for Payer: Cash Price	$158.60
Rate for Payer: Health Management Network Commercial	$207.40
Rate for Payer: Kaiser Permanente Commercial	$219.60
Rate for Payer: MDX Hawaii PPO	$236.68

Know your out-of-pocket cost for care.

All Charges