Leahi Hospital

All Charges

Charge

Type

Setting

Price

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC

Facility

$32,493.34

Service Code	MSDRG 260
Min. Negotiated Rate	$31,168.13
Max. Negotiated Rate	$32,493.34
Rate for Payer: AlohaCare Medicare	$32,493.34
Rate for Payer: Hawaii Medical Service Association Commercial	$31,168.13
Rate for Payer: Hawaii Medical Service Association Medicare	$32,493.34
Rate for Payer: Humana Medicare	$32,493.34
Rate for Payer: Kaiser Permanente Medicare	$32,493.34
Rate for Payer: Ohana Health Plan Medicare	$32,493.34
Rate for Payer: UnitedHealthcare Medicare	$32,493.34

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC

Facility

$31,168.13

Service Code	MSDRG 262
Min. Negotiated Rate	$16,499.07
Max. Negotiated Rate	$31,168.13
Rate for Payer: AlohaCare Medicare	$16,499.07
Rate for Payer: Hawaii Medical Service Association Commercial	$31,168.13
Rate for Payer: Hawaii Medical Service Association Medicare	$16,499.07
Rate for Payer: Humana Medicare	$16,499.07
Rate for Payer: Kaiser Permanente Medicare	$16,499.07
Rate for Payer: Ohana Health Plan Medicare	$16,499.07
Rate for Payer: UnitedHealthcare Medicare	$16,499.07

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC

Facility

$193,360.92

Service Code	MSDRG 217
Min. Negotiated Rate	$65,237.76
Max. Negotiated Rate	$193,360.92
Rate for Payer: AlohaCare Medicare	$65,237.76
Rate for Payer: Hawaii Medical Service Association Commercial	$193,360.92
Rate for Payer: Hawaii Medical Service Association Medicare	$65,237.76
Rate for Payer: Humana Medicare	$65,237.76
Rate for Payer: Kaiser Permanente Medicare	$65,237.76
Rate for Payer: Ohana Health Plan Medicare	$65,237.76
Rate for Payer: UnitedHealthcare Medicare	$65,237.76

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$193,360.92

Service Code	MSDRG 216
Min. Negotiated Rate	$96,848.82
Max. Negotiated Rate	$193,360.92
Rate for Payer: AlohaCare Medicare	$96,848.82
Rate for Payer: Hawaii Medical Service Association Commercial	$193,360.92
Rate for Payer: Hawaii Medical Service Association Medicare	$96,848.82
Rate for Payer: Humana Medicare	$96,848.82
Rate for Payer: Kaiser Permanente Medicare	$96,848.82
Rate for Payer: Ohana Health Plan Medicare	$96,848.82
Rate for Payer: UnitedHealthcare Medicare	$96,848.82

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$193,360.92

Service Code	MSDRG 218
Min. Negotiated Rate	$65,237.76
Max. Negotiated Rate	$193,360.92
Rate for Payer: AlohaCare Medicare	$65,237.76
Rate for Payer: Hawaii Medical Service Association Commercial	$193,360.92
Rate for Payer: Hawaii Medical Service Association Medicare	$65,237.76
Rate for Payer: Humana Medicare	$65,237.76
Rate for Payer: Kaiser Permanente Medicare	$65,237.76
Rate for Payer: Ohana Health Plan Medicare	$65,237.76
Rate for Payer: UnitedHealthcare Medicare	$65,237.76

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC

Facility

$125,762.81

Service Code	MSDRG 220
Min. Negotiated Rate	$52,992.48
Max. Negotiated Rate	$125,762.81
Rate for Payer: AlohaCare Medicare	$52,992.48
Rate for Payer: Hawaii Medical Service Association Commercial	$125,762.81
Rate for Payer: Hawaii Medical Service Association Medicare	$52,992.48
Rate for Payer: Humana Medicare	$52,992.48
Rate for Payer: Kaiser Permanente Medicare	$52,992.48
Rate for Payer: Ohana Health Plan Medicare	$52,992.48
Rate for Payer: UnitedHealthcare Medicare	$52,992.48

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$125,762.81

Service Code	MSDRG 219
Min. Negotiated Rate	$76,108.24
Max. Negotiated Rate	$125,762.81
Rate for Payer: AlohaCare Medicare	$76,108.24
Rate for Payer: Hawaii Medical Service Association Commercial	$125,762.81
Rate for Payer: Hawaii Medical Service Association Medicare	$76,108.24
Rate for Payer: Humana Medicare	$76,108.24
Rate for Payer: Kaiser Permanente Medicare	$76,108.24
Rate for Payer: Ohana Health Plan Medicare	$76,108.24
Rate for Payer: UnitedHealthcare Medicare	$76,108.24

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$125,762.81

Service Code	MSDRG 221
Min. Negotiated Rate	$50,108.80
Max. Negotiated Rate	$125,762.81
Rate for Payer: AlohaCare Medicare	$50,108.80
Rate for Payer: Hawaii Medical Service Association Commercial	$125,762.81
Rate for Payer: Hawaii Medical Service Association Medicare	$50,108.80
Rate for Payer: Humana Medicare	$50,108.80
Rate for Payer: Kaiser Permanente Medicare	$50,108.80
Rate for Payer: Ohana Health Plan Medicare	$50,108.80
Rate for Payer: UnitedHealthcare Medicare	$50,108.80

Caregiver Training - 30-minute

Facility

$222.00

Service Code	HCPCS 97550 GP
Hospital Charge Code	PT97550
Hospital Revenue Code	420
Min. Negotiated Rate	$46.47
Max. Negotiated Rate	$215.34
Rate for Payer: AlohaCare Medicaid	$111.00
Rate for Payer: Cash Price	$144.30
Rate for Payer: Cash Price	$144.30
Rate for Payer: Hawaii Western Management Group Commercial	$210.90
Rate for Payer: Health Management Network Commercial	$188.70
Rate for Payer: Kaiser Permanente Commercial	$199.80
Rate for Payer: Kaiser Permanente Medicaid	$113.22
Rate for Payer: MDX Hawaii PPO	$215.34
Rate for Payer: UnitedHealthcare Medicaid	$46.47
Rate for Payer: University Health Alliance Commercial	$161.82

Caregiver Training - 30-minute

Facility

$222.00

Service Code	HCPCS 97550 GO
Hospital Charge Code	OT97550
Hospital Revenue Code	430
Min. Negotiated Rate	$46.47
Max. Negotiated Rate	$215.34
Rate for Payer: AlohaCare Medicaid	$111.00
Rate for Payer: Cash Price	$144.30
Rate for Payer: Cash Price	$144.30
Rate for Payer: Hawaii Western Management Group Commercial	$210.90
Rate for Payer: Health Management Network Commercial	$188.70
Rate for Payer: Kaiser Permanente Commercial	$199.80
Rate for Payer: Kaiser Permanente Medicaid	$113.22
Rate for Payer: MDX Hawaii PPO	$215.34
Rate for Payer: UnitedHealthcare Medicaid	$46.47
Rate for Payer: University Health Alliance Commercial	$161.82

Caregiver Training - 30-minute

Facility

$222.00

Service Code	HCPCS 97550 GP
Hospital Charge Code	PT97550
Hospital Revenue Code	420
Min. Negotiated Rate	$188.70
Max. Negotiated Rate	$215.34
Rate for Payer: Cash Price	$144.30
Rate for Payer: Health Management Network Commercial	$188.70
Rate for Payer: Kaiser Permanente Commercial	$199.80
Rate for Payer: MDX Hawaii PPO	$215.34

Caregiver Training - 30-minute

Facility

$222.00

Service Code	HCPCS 97550 GO
Hospital Charge Code	OT97550
Hospital Revenue Code	430
Min. Negotiated Rate	$188.70
Max. Negotiated Rate	$215.34
Rate for Payer: Cash Price	$144.30
Rate for Payer: Health Management Network Commercial	$188.70
Rate for Payer: Kaiser Permanente Commercial	$199.80
Rate for Payer: MDX Hawaii PPO	$215.34

Caregiver Training - 30 minutes

Facility

$222.00

Service Code	HCPCS 97550 GN
Hospital Charge Code	ST97550
Hospital Revenue Code	440
Min. Negotiated Rate	$188.70
Max. Negotiated Rate	$215.34
Rate for Payer: Cash Price	$144.30
Rate for Payer: Health Management Network Commercial	$188.70
Rate for Payer: Kaiser Permanente Commercial	$199.80
Rate for Payer: MDX Hawaii PPO	$215.34

Caregiver Training - 30 minutes

Facility

$222.00

Service Code	HCPCS 97550 GN
Hospital Charge Code	ST97550
Hospital Revenue Code	440
Min. Negotiated Rate	$46.47
Max. Negotiated Rate	$215.34
Rate for Payer: AlohaCare Medicaid	$111.00
Rate for Payer: Cash Price	$144.30
Rate for Payer: Cash Price	$144.30
Rate for Payer: Hawaii Western Management Group Commercial	$210.90
Rate for Payer: Health Management Network Commercial	$188.70
Rate for Payer: Kaiser Permanente Commercial	$199.80
Rate for Payer: Kaiser Permanente Medicaid	$113.22
Rate for Payer: MDX Hawaii PPO	$215.34
Rate for Payer: UnitedHealthcare Medicaid	$46.47
Rate for Payer: University Health Alliance Commercial	$161.82

CAROTID ARTERY STENT PROCEDURES WITH CC

Facility

$23,995.06

Service Code	MSDRG 035
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$23,995.06
Rate for Payer: AlohaCare Medicare	$23,995.06
Rate for Payer: Hawaii Medical Service Association Medicare	$23,995.06
Rate for Payer: Humana Medicare	$23,995.06
Rate for Payer: Kaiser Permanente Medicare	$23,995.06
Rate for Payer: Ohana Health Plan Medicare	$23,995.06
Rate for Payer: UnitedHealthcare Medicare	$23,995.06
Rate for Payer: University Health Alliance Commercial	$10,400.00

CAROTID ARTERY STENT PROCEDURES WITH MCC

Facility

$38,582.96

Service Code	MSDRG 034
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$38,582.96
Rate for Payer: AlohaCare Medicare	$38,582.96
Rate for Payer: Hawaii Medical Service Association Medicare	$38,582.96
Rate for Payer: Humana Medicare	$38,582.96
Rate for Payer: Kaiser Permanente Medicare	$38,582.96
Rate for Payer: Ohana Health Plan Medicare	$38,582.96
Rate for Payer: UnitedHealthcare Medicare	$38,582.96
Rate for Payer: University Health Alliance Commercial	$10,400.00

CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC

Facility

$19,582.82

Service Code	MSDRG 036
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$19,582.82
Rate for Payer: AlohaCare Medicare	$19,582.82
Rate for Payer: Hawaii Medical Service Association Medicare	$19,582.82
Rate for Payer: Humana Medicare	$19,582.82
Rate for Payer: Kaiser Permanente Medicare	$19,582.82
Rate for Payer: Ohana Health Plan Medicare	$19,582.82
Rate for Payer: UnitedHealthcare Medicare	$19,582.82
Rate for Payer: University Health Alliance Commercial	$10,400.00

CBC w/auto diff & platelet

Facility

$174.00

Service Code	HCPCS 85025
Hospital Charge Code	85025
Hospital Revenue Code	305
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$168.78
Rate for Payer: AlohaCare Medicaid	$87.00
Rate for Payer: Cash Price	$113.10
Rate for Payer: Cash Price	$113.10
Rate for Payer: Hawaii Medical Service Association ABD	$10.74
Rate for Payer: Hawaii Medical Service Association Commercial	$9.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.28
Rate for Payer: Hawaii Western Management Group Commercial	$7.77
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: Kaiser Permanente Medicaid	$88.74
Rate for Payer: MDX Hawaii PPO	$168.78
Rate for Payer: UnitedHealthcare Medicaid	$10.74
Rate for Payer: University Health Alliance Commercial	$20.09

CBC w/auto diff & platelet

Facility

$174.00

Service Code	HCPCS 85025
Hospital Charge Code	85025
Hospital Revenue Code	305
Min. Negotiated Rate	$147.90
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$113.10
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: MDX Hawaii PPO	$168.78

CBC w/out diff inc platelet

Facility

$132.00

Service Code	HCPCS 85027
Hospital Charge Code	85027
Hospital Revenue Code	305
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$128.04
Rate for Payer: Cash Price	$85.80
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: Kaiser Permanente Commercial	$118.80
Rate for Payer: MDX Hawaii PPO	$128.04

CBC w/out diff inc platelet

Facility

$132.00

Service Code	HCPCS 85027
Hospital Charge Code	85027
Hospital Revenue Code	305
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$128.04
Rate for Payer: AlohaCare Medicaid	$66.00
Rate for Payer: Cash Price	$85.80
Rate for Payer: Cash Price	$85.80
Rate for Payer: Hawaii Medical Service Association ABD	$8.95
Rate for Payer: Hawaii Medical Service Association Commercial	$8.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.40
Rate for Payer: Hawaii Western Management Group Commercial	$6.47
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: Kaiser Permanente Commercial	$118.80
Rate for Payer: Kaiser Permanente Medicaid	$67.32
Rate for Payer: MDX Hawaii PPO	$128.04
Rate for Payer: UnitedHealthcare Medicaid	$8.95
Rate for Payer: University Health Alliance Commercial	$16.72

C Difficile by pcr

Facility

$626.00

Service Code	HCPCS 87493
Hospital Charge Code	87493
Hospital Revenue Code	306
Min. Negotiated Rate	$37.27
Max. Negotiated Rate	$607.22
Rate for Payer: AlohaCare Medicaid	$313.00
Rate for Payer: Cash Price	$406.90
Rate for Payer: Cash Price	$406.90
Rate for Payer: Hawaii Medical Service Association ABD	$50.27
Rate for Payer: Hawaii Medical Service Association Commercial	$46.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$37.27
Rate for Payer: Health Management Network Commercial	$532.10
Rate for Payer: Kaiser Permanente Commercial	$563.40
Rate for Payer: Kaiser Permanente Medicaid	$319.26
Rate for Payer: MDX Hawaii PPO	$607.22
Rate for Payer: UnitedHealthcare Medicaid	$50.27
Rate for Payer: University Health Alliance Commercial	$93.00

C Difficile by pcr

Facility

$626.00

Service Code	HCPCS 87493
Hospital Charge Code	87493
Hospital Revenue Code	306
Min. Negotiated Rate	$532.10
Max. Negotiated Rate	$607.22
Rate for Payer: Cash Price	$406.90
Rate for Payer: Health Management Network Commercial	$532.10
Rate for Payer: Kaiser Permanente Commercial	$563.40
Rate for Payer: MDX Hawaii PPO	$607.22

C Difficile toxins A&B

Facility

$257.00

Service Code	HCPCS 87324
Hospital Charge Code	87324
Hospital Revenue Code	306
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$249.29
Rate for Payer: AlohaCare Medicaid	$128.50
Rate for Payer: Cash Price	$167.05
Rate for Payer: Cash Price	$167.05
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: Kaiser Permanente Medicaid	$131.07
Rate for Payer: MDX Hawaii PPO	$249.29
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: University Health Alliance Commercial	$31.01

C Difficile toxins A&B

Facility

$257.00

Service Code	HCPCS 87324
Hospital Charge Code	87324
Hospital Revenue Code	306
Min. Negotiated Rate	$218.45
Max. Negotiated Rate	$249.29
Rate for Payer: Cash Price	$167.05
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: MDX Hawaii PPO	$249.29

Know your out-of-pocket cost for care.

All Charges