Leahi Hospital

All Charges

Charge

Type

Setting

Price

Vasopnuematic device sup

Facility

$133.00

Service Code	HCPCS 97016 GP
Hospital Charge Code	PT97016
Hospital Revenue Code	420
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$86.45
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: MDX Hawaii PPO	$129.01

Vasopnuematic device sup

Facility

$133.00

Service Code	HCPCS 97016 GP
Hospital Charge Code	PT97016
Hospital Revenue Code	420
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$129.01
Rate for Payer: AlohaCare Medicaid	$66.50
Rate for Payer: Cash Price	$86.45
Rate for Payer: Cash Price	$86.45
Rate for Payer: Hawaii Western Management Group Commercial	$126.35
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: UnitedHealthcare Medicaid	$12.49
Rate for Payer: University Health Alliance Commercial	$96.94

VEIN LIGATION AND STRIPPING

Facility

$32,898.38

Service Code	MSDRG 263
Min. Negotiated Rate	$30,567.60
Max. Negotiated Rate	$32,898.38
Rate for Payer: AlohaCare Medicare	$30,567.60
Rate for Payer: Hawaii Medical Service Association Commercial	$32,898.38
Rate for Payer: Hawaii Medical Service Association Medicare	$30,567.60
Rate for Payer: Humana Medicare	$30,567.60
Rate for Payer: Kaiser Permanente Medicare	$30,567.60
Rate for Payer: Ohana Health Plan Medicare	$30,567.60
Rate for Payer: UnitedHealthcare Medicare	$30,567.60

Venipuncture

Facility

$53.00

Service Code	HCPCS 36415
Hospital Charge Code	36415
Hospital Revenue Code	300
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$51.41
Rate for Payer: AlohaCare Medicaid	$26.50
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Hawaii Medical Service Association Commercial	$11.68
Rate for Payer: Hawaii Western Management Group Commercial	$50.35
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Kaiser Permanente Commercial	$47.70
Rate for Payer: Kaiser Permanente Medicaid	$27.03
Rate for Payer: MDX Hawaii PPO	$51.41
Rate for Payer: UnitedHealthcare Medicaid	$3.00
Rate for Payer: University Health Alliance Commercial	$38.63

Venipuncture

Facility

$53.00

Service Code	HCPCS 36415
Hospital Charge Code	36415
Hospital Revenue Code	300
Min. Negotiated Rate	$45.05
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$34.45
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Kaiser Permanente Commercial	$47.70
Rate for Payer: MDX Hawaii PPO	$51.41

VENTRICULAR SHUNT PROCEDURES WITH CC

Facility

$53,827.24

Service Code	MSDRG 032
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$53,827.24
Rate for Payer: AlohaCare Medicare	$21,437.60
Rate for Payer: Hawaii Medical Service Association Commercial	$53,827.24
Rate for Payer: Hawaii Medical Service Association Medicare	$21,437.60
Rate for Payer: Humana Medicare	$21,437.60
Rate for Payer: Kaiser Permanente Medicare	$21,437.60
Rate for Payer: Ohana Health Plan Medicare	$21,437.60
Rate for Payer: UnitedHealthcare Medicare	$21,437.60
Rate for Payer: University Health Alliance Commercial	$10,400.00

VENTRICULAR SHUNT PROCEDURES WITH MCC

Facility

$53,827.24

Service Code	MSDRG 031
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$53,827.24
Rate for Payer: AlohaCare Medicare	$44,592.76
Rate for Payer: Hawaii Medical Service Association Commercial	$53,827.24
Rate for Payer: Hawaii Medical Service Association Medicare	$44,592.76
Rate for Payer: Humana Medicare	$44,592.76
Rate for Payer: Kaiser Permanente Medicare	$44,592.76
Rate for Payer: Ohana Health Plan Medicare	$44,592.76
Rate for Payer: UnitedHealthcare Medicare	$44,592.76
Rate for Payer: University Health Alliance Commercial	$10,400.00

VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC

Facility

$37,401.76

Service Code	MSDRG 033
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$37,401.76
Rate for Payer: AlohaCare Medicare	$16,824.30
Rate for Payer: Hawaii Medical Service Association Commercial	$37,401.76
Rate for Payer: Hawaii Medical Service Association Medicare	$16,824.30
Rate for Payer: Humana Medicare	$16,824.30
Rate for Payer: Kaiser Permanente Medicare	$16,824.30
Rate for Payer: Ohana Health Plan Medicare	$16,824.30
Rate for Payer: UnitedHealthcare Medicare	$16,824.30
Rate for Payer: University Health Alliance Commercial	$10,400.00

Viamin D 25

Facility

$662.00

Service Code	HCPCS 82306
Hospital Charge Code	82306
Hospital Revenue Code	301
Min. Negotiated Rate	$562.70
Max. Negotiated Rate	$642.14
Rate for Payer: Cash Price	$430.30
Rate for Payer: Health Management Network Commercial	$562.70
Rate for Payer: Kaiser Permanente Commercial	$595.80
Rate for Payer: MDX Hawaii PPO	$642.14

Viamin D 25

Facility

$662.00

Service Code	HCPCS 82306
Hospital Charge Code	82306
Hospital Revenue Code	301
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$642.14
Rate for Payer: AlohaCare Medicaid	$331.00
Rate for Payer: Cash Price	$430.30
Rate for Payer: Cash Price	$430.30
Rate for Payer: Hawaii Medical Service Association ABD	$40.91
Rate for Payer: Hawaii Medical Service Association Commercial	$37.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42.96
Rate for Payer: Hawaii Western Management Group Commercial	$29.60
Rate for Payer: Health Management Network Commercial	$562.70
Rate for Payer: Kaiser Permanente Commercial	$595.80
Rate for Payer: Kaiser Permanente Medicaid	$337.62
Rate for Payer: MDX Hawaii PPO	$642.14
Rate for Payer: UnitedHealthcare Medicaid	$40.91
Rate for Payer: University Health Alliance Commercial	$76.52

VIRAL ILLNESS WITH MCC

Facility

$24,341.95

Service Code	MSDRG 865
Min. Negotiated Rate	$15,202.11
Max. Negotiated Rate	$24,341.95
Rate for Payer: AlohaCare Medicare	$15,202.11
Rate for Payer: Hawaii Medical Service Association Commercial	$24,341.95
Rate for Payer: Hawaii Medical Service Association Medicare	$15,202.11
Rate for Payer: Humana Medicare	$15,202.11
Rate for Payer: Kaiser Permanente Medicare	$15,202.11
Rate for Payer: Ohana Health Plan Medicare	$15,202.11
Rate for Payer: UnitedHealthcare Medicare	$15,202.11

VIRAL ILLNESS WITHOUT MCC

Facility

$22,825.03

Service Code	MSDRG 866
Min. Negotiated Rate	$9,006.05
Max. Negotiated Rate	$22,825.03
Rate for Payer: AlohaCare Medicare	$9,006.05
Rate for Payer: Hawaii Medical Service Association Commercial	$22,825.03
Rate for Payer: Hawaii Medical Service Association Medicare	$9,006.05
Rate for Payer: Humana Medicare	$9,006.05
Rate for Payer: Kaiser Permanente Medicare	$9,006.05
Rate for Payer: Ohana Health Plan Medicare	$9,006.05
Rate for Payer: UnitedHealthcare Medicare	$9,006.05

VIRAL MENINGITIS WITH CC/MCC

Facility

$19,333.48

Service Code	MSDRG 075
Min. Negotiated Rate	$14,102.69
Max. Negotiated Rate	$19,333.48
Rate for Payer: AlohaCare Medicare	$19,333.48
Rate for Payer: Hawaii Medical Service Association Commercial	$14,102.69
Rate for Payer: Hawaii Medical Service Association Medicare	$19,333.48
Rate for Payer: Humana Medicare	$19,333.48
Rate for Payer: Kaiser Permanente Medicare	$19,333.48
Rate for Payer: Ohana Health Plan Medicare	$19,333.48
Rate for Payer: UnitedHealthcare Medicare	$19,333.48

VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$14,102.69

Service Code	MSDRG 076
Min. Negotiated Rate	$8,568.47
Max. Negotiated Rate	$14,102.69
Rate for Payer: AlohaCare Medicare	$8,568.47
Rate for Payer: Hawaii Medical Service Association Commercial	$14,102.69
Rate for Payer: Hawaii Medical Service Association Medicare	$8,568.47
Rate for Payer: Humana Medicare	$8,568.47
Rate for Payer: Kaiser Permanente Medicare	$8,568.47
Rate for Payer: Ohana Health Plan Medicare	$8,568.47
Rate for Payer: UnitedHealthcare Medicare	$8,568.47

Vitamin B12

Facility

$258.00

Service Code	HCPCS 82607
Hospital Charge Code	82607
Hospital Revenue Code	301
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$250.26
Rate for Payer: AlohaCare Medicaid	$129.00
Rate for Payer: Cash Price	$167.70
Rate for Payer: Cash Price	$167.70
Rate for Payer: Hawaii Medical Service Association ABD	$20.83
Rate for Payer: Hawaii Medical Service Association Commercial	$18.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.87
Rate for Payer: Hawaii Western Management Group Commercial	$15.08
Rate for Payer: Health Management Network Commercial	$219.30
Rate for Payer: Kaiser Permanente Commercial	$232.20
Rate for Payer: Kaiser Permanente Medicaid	$131.58
Rate for Payer: MDX Hawaii PPO	$250.26
Rate for Payer: UnitedHealthcare Medicaid	$20.83
Rate for Payer: University Health Alliance Commercial	$38.96

Vitamin B12

Facility

$258.00

Service Code	HCPCS 82607
Hospital Charge Code	82607
Hospital Revenue Code	301
Min. Negotiated Rate	$219.30
Max. Negotiated Rate	$250.26
Rate for Payer: Cash Price	$167.70
Rate for Payer: Health Management Network Commercial	$219.30
Rate for Payer: Kaiser Permanente Commercial	$232.20
Rate for Payer: MDX Hawaii PPO	$250.26

Vit D 25OH

Facility

$418.80

Service Code	HCPCS 82306
Hospital Charge Code	82306-90
Hospital Revenue Code	301
Min. Negotiated Rate	$355.98
Max. Negotiated Rate	$406.24
Rate for Payer: Cash Price	$272.22
Rate for Payer: Health Management Network Commercial	$355.98
Rate for Payer: Kaiser Permanente Commercial	$376.92
Rate for Payer: MDX Hawaii PPO	$406.24

Vit D 25OH

Facility

$418.80

Service Code	HCPCS 82306
Hospital Charge Code	82306-90
Hospital Revenue Code	301
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$406.24
Rate for Payer: AlohaCare Medicaid	$209.40
Rate for Payer: Cash Price	$272.22
Rate for Payer: Cash Price	$272.22
Rate for Payer: Hawaii Medical Service Association ABD	$40.91
Rate for Payer: Hawaii Medical Service Association Commercial	$37.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42.96
Rate for Payer: Hawaii Western Management Group Commercial	$29.60
Rate for Payer: Health Management Network Commercial	$355.98
Rate for Payer: Kaiser Permanente Commercial	$376.92
Rate for Payer: Kaiser Permanente Medicaid	$213.59
Rate for Payer: MDX Hawaii PPO	$406.24
Rate for Payer: UnitedHealthcare Medicaid	$40.91
Rate for Payer: University Health Alliance Commercial	$76.52

Wheelchair Management Training

Facility

$208.00

Service Code	HCPCS 97542 GO
Hospital Charge Code	OT97542
Hospital Revenue Code	430
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$135.20
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: MDX Hawaii PPO	$201.76

Wheelchair Management Training

Facility

$208.00

Service Code	HCPCS 97542 GO
Hospital Charge Code	OT97542
Hospital Revenue Code	430
Min. Negotiated Rate	$17.54
Max. Negotiated Rate	$201.76
Rate for Payer: AlohaCare Medicaid	$104.00
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cash Price	$135.20
Rate for Payer: Hawaii Western Management Group Commercial	$197.60
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: UnitedHealthcare Medicaid	$17.54
Rate for Payer: University Health Alliance Commercial	$151.61

Wheelchair mgmt-15 min

Facility

$208.00

Service Code	HCPCS 97542 GP
Hospital Charge Code	PT97542
Hospital Revenue Code	420
Min. Negotiated Rate	$17.54
Max. Negotiated Rate	$201.76
Rate for Payer: AlohaCare Medicaid	$104.00
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cash Price	$135.20
Rate for Payer: Hawaii Western Management Group Commercial	$197.60
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: UnitedHealthcare Medicaid	$17.54
Rate for Payer: University Health Alliance Commercial	$151.61

Wheelchair mgmt-15 min

Facility

$208.00

Service Code	HCPCS 97542 GP
Hospital Charge Code	PT97542
Hospital Revenue Code	420
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$135.20
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: MDX Hawaii PPO	$201.76

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$101,136.43

Service Code	MSDRG 464
Min. Negotiated Rate	$31,132.31
Max. Negotiated Rate	$101,136.43
Rate for Payer: AlohaCare Medicare	$31,132.31
Rate for Payer: Hawaii Medical Service Association Commercial	$101,136.43
Rate for Payer: Hawaii Medical Service Association Medicare	$31,132.31
Rate for Payer: Humana Medicare	$31,132.31
Rate for Payer: Kaiser Permanente Medicare	$31,132.31
Rate for Payer: Ohana Health Plan Medicare	$31,132.31
Rate for Payer: UnitedHealthcare Medicare	$31,132.31

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$101,136.43

Service Code	MSDRG 463
Min. Negotiated Rate	$56,606.44
Max. Negotiated Rate	$101,136.43
Rate for Payer: AlohaCare Medicare	$56,606.44
Rate for Payer: Hawaii Medical Service Association Commercial	$101,136.43
Rate for Payer: Hawaii Medical Service Association Medicare	$56,606.44
Rate for Payer: Humana Medicare	$56,606.44
Rate for Payer: Kaiser Permanente Medicare	$56,606.44
Rate for Payer: Ohana Health Plan Medicare	$56,606.44
Rate for Payer: UnitedHealthcare Medicare	$56,606.44

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$101,136.43

Service Code	MSDRG 465
Min. Negotiated Rate	$18,409.05
Max. Negotiated Rate	$101,136.43
Rate for Payer: AlohaCare Medicare	$18,409.05
Rate for Payer: Hawaii Medical Service Association Commercial	$101,136.43
Rate for Payer: Hawaii Medical Service Association Medicare	$18,409.05
Rate for Payer: Humana Medicare	$18,409.05
Rate for Payer: Kaiser Permanente Medicare	$18,409.05
Rate for Payer: Ohana Health Plan Medicare	$18,409.05
Rate for Payer: UnitedHealthcare Medicare	$18,409.05

Know your out-of-pocket cost for care.

All Charges