Leahi Hospital

All Charges

Charge

Type

Setting

Price

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$47,830.64

Service Code	MSDRG 478
Min. Negotiated Rate	$24,672.12
Max. Negotiated Rate	$47,830.64
Rate for Payer: AlohaCare Medicare	$24,672.12
Rate for Payer: Hawaii Medical Service Association Commercial	$47,830.64
Rate for Payer: Hawaii Medical Service Association Medicare	$24,672.12
Rate for Payer: Humana Medicare	$24,672.12
Rate for Payer: Kaiser Permanente Medicare	$24,672.12
Rate for Payer: Ohana Health Plan Medicare	$24,672.12
Rate for Payer: UnitedHealthcare Medicare	$24,672.12

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$47,830.64

Service Code	MSDRG 477
Min. Negotiated Rate	$34,482.15
Max. Negotiated Rate	$47,830.64
Rate for Payer: AlohaCare Medicare	$34,482.15
Rate for Payer: Hawaii Medical Service Association Commercial	$47,830.64
Rate for Payer: Hawaii Medical Service Association Medicare	$34,482.15
Rate for Payer: Humana Medicare	$34,482.15
Rate for Payer: Kaiser Permanente Medicare	$34,482.15
Rate for Payer: Ohana Health Plan Medicare	$34,482.15
Rate for Payer: UnitedHealthcare Medicare	$34,482.15

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$47,830.64

Service Code	MSDRG 479
Min. Negotiated Rate	$18,755.95
Max. Negotiated Rate	$47,830.64
Rate for Payer: AlohaCare Medicare	$18,755.95
Rate for Payer: Hawaii Medical Service Association Commercial	$47,830.64
Rate for Payer: Hawaii Medical Service Association Medicare	$18,755.95
Rate for Payer: Humana Medicare	$18,755.95
Rate for Payer: Kaiser Permanente Medicare	$18,755.95
Rate for Payer: Ohana Health Plan Medicare	$18,755.95
Rate for Payer: UnitedHealthcare Medicare	$18,755.95

Bk Virus DNA Qnt Pcr SO

Facility

$728.00

Service Code	HCPCS 87799
Hospital Charge Code	87799
Hospital Revenue Code	306
Min. Negotiated Rate	$35.91
Max. Negotiated Rate	$706.16
Rate for Payer: AlohaCare Medicaid	$364.00
Rate for Payer: Cash Price	$473.20
Rate for Payer: Cash Price	$473.20
Rate for Payer: Hawaii Medical Service Association ABD	$35.91
Rate for Payer: Hawaii Medical Service Association Commercial	$53.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.17
Rate for Payer: Hawaii Western Management Group Commercial	$42.84
Rate for Payer: Health Management Network Commercial	$618.80
Rate for Payer: Kaiser Permanente Commercial	$655.20
Rate for Payer: Kaiser Permanente Medicaid	$371.28
Rate for Payer: MDX Hawaii PPO	$706.16
Rate for Payer: UnitedHealthcare Medicaid	$35.91
Rate for Payer: University Health Alliance Commercial	$110.72

Bk Virus DNA Qnt Pcr SO

Facility

$728.00

Service Code	HCPCS 87799
Hospital Charge Code	87799
Hospital Revenue Code	306
Min. Negotiated Rate	$618.80
Max. Negotiated Rate	$706.16
Rate for Payer: Cash Price	$473.20
Rate for Payer: Health Management Network Commercial	$618.80
Rate for Payer: Kaiser Permanente Commercial	$655.20
Rate for Payer: MDX Hawaii PPO	$706.16

BONE DISEASES AND ARTHROPATHIES WITH MCC

Facility

$13,211.32

Service Code	MSDRG 553
Min. Negotiated Rate	$12,490.95
Max. Negotiated Rate	$13,211.32
Rate for Payer: AlohaCare Medicare	$13,211.32
Rate for Payer: Hawaii Medical Service Association Commercial	$12,490.95
Rate for Payer: Hawaii Medical Service Association Medicare	$13,211.32
Rate for Payer: Humana Medicare	$13,211.32
Rate for Payer: Kaiser Permanente Medicare	$13,211.32
Rate for Payer: Ohana Health Plan Medicare	$13,211.32
Rate for Payer: UnitedHealthcare Medicare	$13,211.32

BONE DISEASES AND ARTHROPATHIES WITHOUT MCC

Facility

$12,396.15

Service Code	MSDRG 554
Min. Negotiated Rate	$8,616.76
Max. Negotiated Rate	$12,396.15
Rate for Payer: AlohaCare Medicare	$8,616.76
Rate for Payer: Hawaii Medical Service Association Commercial	$12,396.15
Rate for Payer: Hawaii Medical Service Association Medicare	$8,616.76
Rate for Payer: Humana Medicare	$8,616.76
Rate for Payer: Kaiser Permanente Medicare	$8,616.76
Rate for Payer: Ohana Health Plan Medicare	$8,616.76
Rate for Payer: UnitedHealthcare Medicare	$8,616.76

BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC

Facility

$25,171.52

Service Code	MSDRG 584
Min. Negotiated Rate	$21,533.20
Max. Negotiated Rate	$25,171.52
Rate for Payer: AlohaCare Medicare	$21,533.20
Rate for Payer: Hawaii Medical Service Association Commercial	$25,171.52
Rate for Payer: Hawaii Medical Service Association Medicare	$21,533.20
Rate for Payer: Humana Medicare	$21,533.20
Rate for Payer: Kaiser Permanente Medicare	$21,533.20
Rate for Payer: Ohana Health Plan Medicare	$21,533.20
Rate for Payer: UnitedHealthcare Medicare	$21,533.20

BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC

Facility

$24,365.66

Service Code	MSDRG 585
Min. Negotiated Rate	$19,447.80
Max. Negotiated Rate	$24,365.66
Rate for Payer: AlohaCare Medicare	$19,447.80
Rate for Payer: Hawaii Medical Service Association Commercial	$24,365.66
Rate for Payer: Hawaii Medical Service Association Medicare	$19,447.80
Rate for Payer: Humana Medicare	$19,447.80
Rate for Payer: Kaiser Permanente Medicare	$19,447.80
Rate for Payer: Ohana Health Plan Medicare	$19,447.80
Rate for Payer: UnitedHealthcare Medicare	$19,447.80

BRONCHITIS AND ASTHMA WITH CC/MCC

Facility

$17,800.20

Service Code	MSDRG 202
Min. Negotiated Rate	$10,007.36
Max. Negotiated Rate	$17,800.20
Rate for Payer: AlohaCare Medicare	$10,007.36
Rate for Payer: Hawaii Medical Service Association Commercial	$17,800.20
Rate for Payer: Hawaii Medical Service Association Medicare	$10,007.36
Rate for Payer: Humana Medicare	$10,007.36
Rate for Payer: Kaiser Permanente Medicare	$10,007.36
Rate for Payer: Ohana Health Plan Medicare	$10,007.36
Rate for Payer: UnitedHealthcare Medicare	$10,007.36

BRONCHITIS AND ASTHMA WITHOUT CC/MCC

Facility

$13,533.84

Service Code	MSDRG 203
Min. Negotiated Rate	$7,038.91
Max. Negotiated Rate	$13,533.84
Rate for Payer: AlohaCare Medicare	$7,038.91
Rate for Payer: Hawaii Medical Service Association Commercial	$13,533.84
Rate for Payer: Hawaii Medical Service Association Medicare	$7,038.91
Rate for Payer: Humana Medicare	$7,038.91
Rate for Payer: Kaiser Permanente Medicare	$7,038.91
Rate for Payer: Ohana Health Plan Medicare	$7,038.91
Rate for Payer: UnitedHealthcare Medicare	$7,038.91

CARDIAC ARREST, UNEXPLAINED WITH CC

Facility

$44,678.27

Service Code	MSDRG 297
Min. Negotiated Rate	$6,684.13
Max. Negotiated Rate	$44,678.27
Rate for Payer: AlohaCare Medicare	$6,684.13
Rate for Payer: Hawaii Medical Service Association Commercial	$44,678.27
Rate for Payer: Hawaii Medical Service Association Medicare	$6,684.13
Rate for Payer: Humana Medicare	$6,684.13
Rate for Payer: Kaiser Permanente Medicare	$6,684.13
Rate for Payer: Ohana Health Plan Medicare	$6,684.13
Rate for Payer: UnitedHealthcare Medicare	$6,684.13

CARDIAC ARREST, UNEXPLAINED WITH MCC

Facility

$44,678.27

Service Code	MSDRG 296
Min. Negotiated Rate	$15,828.92
Max. Negotiated Rate	$44,678.27
Rate for Payer: AlohaCare Medicare	$15,828.92
Rate for Payer: Hawaii Medical Service Association Commercial	$44,678.27
Rate for Payer: Hawaii Medical Service Association Medicare	$15,828.92
Rate for Payer: Humana Medicare	$15,828.92
Rate for Payer: Kaiser Permanente Medicare	$15,828.92
Rate for Payer: Ohana Health Plan Medicare	$15,828.92
Rate for Payer: UnitedHealthcare Medicare	$15,828.92

CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC

Facility

$44,678.27

Service Code	MSDRG 298
Min. Negotiated Rate	$4,921.00
Max. Negotiated Rate	$44,678.27
Rate for Payer: AlohaCare Medicare	$4,921.00
Rate for Payer: Hawaii Medical Service Association Commercial	$44,678.27
Rate for Payer: Hawaii Medical Service Association Medicare	$4,921.00
Rate for Payer: Humana Medicare	$4,921.00
Rate for Payer: Kaiser Permanente Medicare	$4,921.00
Rate for Payer: Ohana Health Plan Medicare	$4,921.00
Rate for Payer: UnitedHealthcare Medicare	$4,921.00

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC

Facility

$19,814.87

Service Code	MSDRG 309
Min. Negotiated Rate	$7,686.42
Max. Negotiated Rate	$19,814.87
Rate for Payer: AlohaCare Medicare	$7,686.42
Rate for Payer: Hawaii Medical Service Association Commercial	$19,814.87
Rate for Payer: Hawaii Medical Service Association Medicare	$7,686.42
Rate for Payer: Humana Medicare	$7,686.42
Rate for Payer: Kaiser Permanente Medicare	$7,686.42
Rate for Payer: Ohana Health Plan Medicare	$7,686.42
Rate for Payer: UnitedHealthcare Medicare	$7,686.42

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC

Facility

$21,118.48

Service Code	MSDRG 308
Min. Negotiated Rate	$12,301.68
Max. Negotiated Rate	$21,118.48
Rate for Payer: AlohaCare Medicare	$12,301.68
Rate for Payer: Hawaii Medical Service Association Commercial	$21,118.48
Rate for Payer: Hawaii Medical Service Association Medicare	$12,301.68
Rate for Payer: Humana Medicare	$12,301.68
Rate for Payer: Kaiser Permanente Medicare	$12,301.68
Rate for Payer: Ohana Health Plan Medicare	$12,301.68
Rate for Payer: UnitedHealthcare Medicare	$12,301.68

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC

Facility

$15,192.98

Service Code	MSDRG 310
Min. Negotiated Rate	$6,014.96
Max. Negotiated Rate	$15,192.98
Rate for Payer: AlohaCare Medicare	$6,014.96
Rate for Payer: Hawaii Medical Service Association Commercial	$15,192.98
Rate for Payer: Hawaii Medical Service Association Medicare	$6,014.96
Rate for Payer: Humana Medicare	$6,014.96
Rate for Payer: Kaiser Permanente Medicare	$6,014.96
Rate for Payer: Ohana Health Plan Medicare	$6,014.96
Rate for Payer: UnitedHealthcare Medicare	$6,014.96

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC

Facility

$15,965.90

Service Code	MSDRG 306
Min. Negotiated Rate	$13,960.48
Max. Negotiated Rate	$15,965.90
Rate for Payer: AlohaCare Medicare	$15,965.90
Rate for Payer: Hawaii Medical Service Association Commercial	$13,960.48
Rate for Payer: Hawaii Medical Service Association Medicare	$15,965.90
Rate for Payer: Humana Medicare	$15,965.90
Rate for Payer: Kaiser Permanente Medicare	$15,965.90
Rate for Payer: Ohana Health Plan Medicare	$15,965.90
Rate for Payer: UnitedHealthcare Medicare	$15,965.90

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC

Facility

$12,893.89

Service Code	MSDRG 307
Min. Negotiated Rate	$9,435.74
Max. Negotiated Rate	$12,893.89
Rate for Payer: AlohaCare Medicare	$9,435.74
Rate for Payer: Hawaii Medical Service Association Commercial	$12,893.89
Rate for Payer: Hawaii Medical Service Association Medicare	$9,435.74
Rate for Payer: Humana Medicare	$9,435.74
Rate for Payer: Kaiser Permanente Medicare	$9,435.74
Rate for Payer: Ohana Health Plan Medicare	$9,435.74
Rate for Payer: UnitedHealthcare Medicare	$9,435.74

CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC

Facility

$160,035.90

Service Code	MSDRG 275
Min. Negotiated Rate	$70,708.47
Max. Negotiated Rate	$160,035.90
Rate for Payer: AlohaCare Medicare	$70,708.47
Rate for Payer: Hawaii Medical Service Association Commercial	$160,035.90
Rate for Payer: Hawaii Medical Service Association Medicare	$70,708.47
Rate for Payer: Humana Medicare	$70,708.47
Rate for Payer: Kaiser Permanente Medicare	$70,708.47
Rate for Payer: Ohana Health Plan Medicare	$70,708.47
Rate for Payer: UnitedHealthcare Medicare	$70,708.47

CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR

Facility

$103,008.89

Service Code	MSDRG 276
Min. Negotiated Rate	$59,633.02
Max. Negotiated Rate	$103,008.89
Rate for Payer: AlohaCare Medicare	$59,633.02
Rate for Payer: Hawaii Medical Service Association Commercial	$103,008.89
Rate for Payer: Hawaii Medical Service Association Medicare	$59,633.02
Rate for Payer: Humana Medicare	$59,633.02
Rate for Payer: Kaiser Permanente Medicare	$59,633.02
Rate for Payer: Ohana Health Plan Medicare	$59,633.02
Rate for Payer: UnitedHealthcare Medicare	$59,633.02

CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC

Facility

$103,008.89

Service Code	MSDRG 277
Min. Negotiated Rate	$45,952.80
Max. Negotiated Rate	$103,008.89
Rate for Payer: AlohaCare Medicare	$45,952.80
Rate for Payer: Hawaii Medical Service Association Commercial	$103,008.89
Rate for Payer: Hawaii Medical Service Association Medicare	$45,952.80
Rate for Payer: Humana Medicare	$45,952.80
Rate for Payer: Kaiser Permanente Medicare	$45,952.80
Rate for Payer: Ohana Health Plan Medicare	$45,952.80
Rate for Payer: UnitedHealthcare Medicare	$45,952.80

CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC

Facility

$31,402.35

Service Code	MSDRG 258
Min. Negotiated Rate	$23,085.75
Max. Negotiated Rate	$31,402.35
Rate for Payer: AlohaCare Medicare	$31,402.35
Rate for Payer: Hawaii Medical Service Association Commercial	$23,085.75
Rate for Payer: Hawaii Medical Service Association Medicare	$31,402.35
Rate for Payer: Humana Medicare	$31,402.35
Rate for Payer: Kaiser Permanente Medicare	$31,402.35
Rate for Payer: Ohana Health Plan Medicare	$31,402.35
Rate for Payer: UnitedHealthcare Medicare	$31,402.35

CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC

Facility

$23,085.75

Service Code	MSDRG 259
Min. Negotiated Rate	$20,364.35
Max. Negotiated Rate	$23,085.75
Rate for Payer: AlohaCare Medicare	$20,364.35
Rate for Payer: Hawaii Medical Service Association Commercial	$23,085.75
Rate for Payer: Hawaii Medical Service Association Medicare	$20,364.35
Rate for Payer: Humana Medicare	$20,364.35
Rate for Payer: Kaiser Permanente Medicare	$20,364.35
Rate for Payer: Ohana Health Plan Medicare	$20,364.35
Rate for Payer: UnitedHealthcare Medicare	$20,364.35

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC

Facility

$31,168.13

Service Code	MSDRG 261
Min. Negotiated Rate	$19,067.39
Max. Negotiated Rate	$31,168.13
Rate for Payer: AlohaCare Medicare	$19,067.39
Rate for Payer: Hawaii Medical Service Association Commercial	$31,168.13
Rate for Payer: Hawaii Medical Service Association Medicare	$19,067.39
Rate for Payer: Humana Medicare	$19,067.39
Rate for Payer: Kaiser Permanente Medicare	$19,067.39
Rate for Payer: Ohana Health Plan Medicare	$19,067.39
Rate for Payer: UnitedHealthcare Medicare	$19,067.39

Know your out-of-pocket cost for care.

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