Leahi Hospital

All Charges

Charge

Type

Setting

Price

COMPLICATED PEPTIC ULCER WITH MCC

Facility

$23,796.81

Service Code	MSDRG 380
Min. Negotiated Rate	$19,774.01
Max. Negotiated Rate	$23,796.81
Rate for Payer: AlohaCare Medicare	$19,774.01
Rate for Payer: Hawaii Medical Service Association Commercial	$23,796.81
Rate for Payer: Hawaii Medical Service Association Medicare	$19,774.01
Rate for Payer: Humana Medicare	$19,774.01
Rate for Payer: Kaiser Permanente Medicare	$19,774.01
Rate for Payer: Ohana Health Plan Medicare	$19,774.01
Rate for Payer: UnitedHealthcare Medicare	$19,774.01

COMPLICATED PEPTIC ULCER WITHOUT CC/MCC

Facility

$23,796.81

Service Code	MSDRG 382
Min. Negotiated Rate	$8,326.03
Max. Negotiated Rate	$23,796.81
Rate for Payer: AlohaCare Medicare	$8,326.03
Rate for Payer: Hawaii Medical Service Association Commercial	$23,796.81
Rate for Payer: Hawaii Medical Service Association Medicare	$8,326.03
Rate for Payer: Humana Medicare	$8,326.03
Rate for Payer: Kaiser Permanente Medicare	$8,326.03
Rate for Payer: Ohana Health Plan Medicare	$8,326.03
Rate for Payer: UnitedHealthcare Medicare	$8,326.03

COMPLICATIONS OF TREATMENT WITH CC

Facility

$27,826.15

Service Code	MSDRG 920
Min. Negotiated Rate	$10,313.85
Max. Negotiated Rate	$27,826.15
Rate for Payer: AlohaCare Medicare	$10,313.85
Rate for Payer: Hawaii Medical Service Association Commercial	$27,826.15
Rate for Payer: Hawaii Medical Service Association Medicare	$10,313.85
Rate for Payer: Humana Medicare	$10,313.85
Rate for Payer: Kaiser Permanente Medicare	$10,313.85
Rate for Payer: Ohana Health Plan Medicare	$10,313.85
Rate for Payer: UnitedHealthcare Medicare	$10,313.85

COMPLICATIONS OF TREATMENT WITH MCC

Facility

$27,826.15

Service Code	MSDRG 919
Min. Negotiated Rate	$18,479.01
Max. Negotiated Rate	$27,826.15
Rate for Payer: AlohaCare Medicare	$18,479.01
Rate for Payer: Hawaii Medical Service Association Commercial	$27,826.15
Rate for Payer: Hawaii Medical Service Association Medicare	$18,479.01
Rate for Payer: Humana Medicare	$18,479.01
Rate for Payer: Kaiser Permanente Medicare	$18,479.01
Rate for Payer: Ohana Health Plan Medicare	$18,479.01
Rate for Payer: UnitedHealthcare Medicare	$18,479.01

COMPLICATIONS OF TREATMENT WITHOUT CC/MCC

Facility

$15,761.83

Service Code	MSDRG 921
Min. Negotiated Rate	$7,220.25
Max. Negotiated Rate	$15,761.83
Rate for Payer: AlohaCare Medicare	$7,220.25
Rate for Payer: Hawaii Medical Service Association Commercial	$15,761.83
Rate for Payer: Hawaii Medical Service Association Medicare	$7,220.25
Rate for Payer: Humana Medicare	$7,220.25
Rate for Payer: Kaiser Permanente Medicare	$7,220.25
Rate for Payer: Ohana Health Plan Medicare	$7,220.25
Rate for Payer: UnitedHealthcare Medicare	$7,220.25

Comp Metabolic Panel

Facility

$223.00

Service Code	HCPCS 80053
Hospital Charge Code	80053
Hospital Revenue Code	301
Min. Negotiated Rate	$189.55
Max. Negotiated Rate	$216.31
Rate for Payer: Cash Price	$144.95
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Kaiser Permanente Commercial	$200.70
Rate for Payer: MDX Hawaii PPO	$216.31

Comp Metabolic Panel

Facility

$223.00

Service Code	HCPCS 80053
Hospital Charge Code	80053
Hospital Revenue Code	301
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$216.31
Rate for Payer: AlohaCare Medicaid	$111.50
Rate for Payer: Cash Price	$144.95
Rate for Payer: Cash Price	$144.95
Rate for Payer: Hawaii Medical Service Association ABD	$14.61
Rate for Payer: Hawaii Medical Service Association Commercial	$13.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.34
Rate for Payer: Hawaii Western Management Group Commercial	$10.56
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Kaiser Permanente Commercial	$200.70
Rate for Payer: Kaiser Permanente Medicaid	$113.73
Rate for Payer: MDX Hawaii PPO	$216.31
Rate for Payer: UnitedHealthcare Medicaid	$14.61
Rate for Payer: University Health Alliance Commercial	$27.32

Concentration AFB

Facility

$143.00

Service Code	HCPCS 87015
Hospital Charge Code	87015
Hospital Revenue Code	306
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$138.71
Rate for Payer: AlohaCare Medicaid	$71.50
Rate for Payer: Cash Price	$92.95
Rate for Payer: Cash Price	$92.95
Rate for Payer: Hawaii Medical Service Association ABD	$9.23
Rate for Payer: Hawaii Medical Service Association Commercial	$8.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.69
Rate for Payer: Hawaii Western Management Group Commercial	$6.68
Rate for Payer: Health Management Network Commercial	$121.55
Rate for Payer: Kaiser Permanente Commercial	$128.70
Rate for Payer: Kaiser Permanente Medicaid	$72.93
Rate for Payer: MDX Hawaii PPO	$138.71
Rate for Payer: UnitedHealthcare Medicaid	$9.23
Rate for Payer: University Health Alliance Commercial	$17.26

Concentration AFB

Facility

$143.00

Service Code	HCPCS 87015
Hospital Charge Code	87015
Hospital Revenue Code	306
Min. Negotiated Rate	$121.55
Max. Negotiated Rate	$138.71
Rate for Payer: Cash Price	$92.95
Rate for Payer: Health Management Network Commercial	$121.55
Rate for Payer: Kaiser Permanente Commercial	$128.70
Rate for Payer: MDX Hawaii PPO	$138.71

CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES

Facility

$127,540.46

Service Code	MSDRG 212
Min. Negotiated Rate	$107,603.99
Max. Negotiated Rate	$127,540.46
Rate for Payer: AlohaCare Medicare	$107,603.99
Rate for Payer: Hawaii Medical Service Association Commercial	$127,540.46
Rate for Payer: Hawaii Medical Service Association Medicare	$107,603.99
Rate for Payer: Humana Medicare	$107,603.99
Rate for Payer: Kaiser Permanente Medicare	$107,603.99
Rate for Payer: Ohana Health Plan Medicare	$107,603.99
Rate for Payer: UnitedHealthcare Medicare	$107,603.99

CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION

Facility

$66,333.68

Service Code	MSDRG 317
Min. Negotiated Rate	$66,333.68
Max. Negotiated Rate	$66,333.68
Rate for Payer: AlohaCare Medicare	$66,333.68
Rate for Payer: Hawaii Medical Service Association Medicare	$66,333.68
Rate for Payer: Humana Medicare	$66,333.68
Rate for Payer: Kaiser Permanente Medicare	$66,333.68
Rate for Payer: Ohana Health Plan Medicare	$66,333.68
Rate for Payer: UnitedHealthcare Medicare	$66,333.68

CONCUSSION WITH CC

Facility

$22,493.20

Service Code	MSDRG 089
Min. Negotiated Rate	$11,262.93
Max. Negotiated Rate	$22,493.20
Rate for Payer: AlohaCare Medicare	$11,262.93
Rate for Payer: Hawaii Medical Service Association Commercial	$22,493.20
Rate for Payer: Hawaii Medical Service Association Medicare	$11,262.93
Rate for Payer: Humana Medicare	$11,262.93
Rate for Payer: Kaiser Permanente Medicare	$11,262.93
Rate for Payer: Ohana Health Plan Medicare	$11,262.93
Rate for Payer: UnitedHealthcare Medicare	$11,262.93

CONCUSSION WITH MCC

Facility

$22,493.20

Service Code	MSDRG 088
Min. Negotiated Rate	$13,758.30
Max. Negotiated Rate	$22,493.20
Rate for Payer: AlohaCare Medicare	$13,758.30
Rate for Payer: Hawaii Medical Service Association Commercial	$22,493.20
Rate for Payer: Hawaii Medical Service Association Medicare	$13,758.30
Rate for Payer: Humana Medicare	$13,758.30
Rate for Payer: Kaiser Permanente Medicare	$13,758.30
Rate for Payer: Ohana Health Plan Medicare	$13,758.30
Rate for Payer: UnitedHealthcare Medicare	$13,758.30

CONCUSSION WITHOUT CC/MCC

Facility

$16,781.02

Service Code	MSDRG 090
Min. Negotiated Rate	$8,548.76
Max. Negotiated Rate	$16,781.02
Rate for Payer: AlohaCare Medicare	$8,548.76
Rate for Payer: Hawaii Medical Service Association Commercial	$16,781.02
Rate for Payer: Hawaii Medical Service Association Medicare	$8,548.76
Rate for Payer: Humana Medicare	$8,548.76
Rate for Payer: Kaiser Permanente Medicare	$8,548.76
Rate for Payer: Ohana Health Plan Medicare	$8,548.76
Rate for Payer: UnitedHealthcare Medicare	$8,548.76

CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$34,652.32

Service Code	MSDRG 546
Min. Negotiated Rate	$11,802.99
Max. Negotiated Rate	$34,652.32
Rate for Payer: AlohaCare Medicare	$11,802.99
Rate for Payer: Hawaii Medical Service Association Commercial	$34,652.32
Rate for Payer: Hawaii Medical Service Association Medicare	$11,802.99
Rate for Payer: Humana Medicare	$11,802.99
Rate for Payer: Kaiser Permanente Medicare	$11,802.99
Rate for Payer: Ohana Health Plan Medicare	$11,802.99
Rate for Payer: UnitedHealthcare Medicare	$11,802.99

CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$40,032.68

Service Code	MSDRG 545
Min. Negotiated Rate	$24,893.87
Max. Negotiated Rate	$40,032.68
Rate for Payer: AlohaCare Medicare	$24,893.87
Rate for Payer: Hawaii Medical Service Association Commercial	$40,032.68
Rate for Payer: Hawaii Medical Service Association Medicare	$24,893.87
Rate for Payer: Humana Medicare	$24,893.87
Rate for Payer: Kaiser Permanente Medicare	$24,893.87
Rate for Payer: Ohana Health Plan Medicare	$24,893.87
Rate for Payer: UnitedHealthcare Medicare	$24,893.87

CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$29,295.67

Service Code	MSDRG 547
Min. Negotiated Rate	$8,676.88
Max. Negotiated Rate	$29,295.67
Rate for Payer: AlohaCare Medicare	$8,676.88
Rate for Payer: Hawaii Medical Service Association Commercial	$29,295.67
Rate for Payer: Hawaii Medical Service Association Medicare	$8,676.88
Rate for Payer: Humana Medicare	$8,676.88
Rate for Payer: Kaiser Permanente Medicare	$8,676.88
Rate for Payer: Ohana Health Plan Medicare	$8,676.88
Rate for Payer: UnitedHealthcare Medicare	$8,676.88

Contrast bath 15 min ca

Facility

$103.00

Service Code	HCPCS 97034 GO
Hospital Charge Code	OT97034
Hospital Revenue Code	430
Min. Negotiated Rate	$11.39
Max. Negotiated Rate	$99.91
Rate for Payer: AlohaCare Medicaid	$51.50
Rate for Payer: Cash Price	$66.95
Rate for Payer: Cash Price	$66.95
Rate for Payer: Hawaii Western Management Group Commercial	$97.85
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Kaiser Permanente Commercial	$92.70
Rate for Payer: Kaiser Permanente Medicaid	$52.53
Rate for Payer: MDX Hawaii PPO	$99.91
Rate for Payer: UnitedHealthcare Medicaid	$11.39
Rate for Payer: University Health Alliance Commercial	$75.08

Contrast bath 15 min ca

Facility

$103.00

Service Code	HCPCS 97034 GO
Hospital Charge Code	OT97034
Hospital Revenue Code	430
Min. Negotiated Rate	$87.55
Max. Negotiated Rate	$99.91
Rate for Payer: Cash Price	$66.95
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Kaiser Permanente Commercial	$92.70
Rate for Payer: MDX Hawaii PPO	$99.91

Contrast baths 15 min ca

Facility

$103.00

Service Code	HCPCS 97034 GP
Hospital Charge Code	PT97034
Hospital Revenue Code	420
Min. Negotiated Rate	$11.39
Max. Negotiated Rate	$99.91
Rate for Payer: AlohaCare Medicaid	$51.50
Rate for Payer: Cash Price	$66.95
Rate for Payer: Cash Price	$66.95
Rate for Payer: Hawaii Western Management Group Commercial	$97.85
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Kaiser Permanente Commercial	$92.70
Rate for Payer: Kaiser Permanente Medicaid	$52.53
Rate for Payer: MDX Hawaii PPO	$99.91
Rate for Payer: UnitedHealthcare Medicaid	$11.39
Rate for Payer: University Health Alliance Commercial	$75.08

Contrast baths 15 min ca

Facility

$103.00

Service Code	HCPCS 97034 GP
Hospital Charge Code	PT97034
Hospital Revenue Code	420
Min. Negotiated Rate	$87.55
Max. Negotiated Rate	$99.91
Rate for Payer: Cash Price	$66.95
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Kaiser Permanente Commercial	$92.70
Rate for Payer: MDX Hawaii PPO	$99.91

CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC

Facility

$127,327.14

Service Code	MSDRG 233
Min. Negotiated Rate	$75,782.01
Max. Negotiated Rate	$127,327.14
Rate for Payer: AlohaCare Medicare	$75,782.01
Rate for Payer: Hawaii Medical Service Association Commercial	$127,327.14
Rate for Payer: Hawaii Medical Service Association Medicare	$75,782.01
Rate for Payer: Humana Medicare	$75,782.01
Rate for Payer: Kaiser Permanente Medicare	$75,782.01
Rate for Payer: Ohana Health Plan Medicare	$75,782.01
Rate for Payer: UnitedHealthcare Medicare	$75,782.01

CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC

Facility

$111,754.93

Service Code	MSDRG 234
Min. Negotiated Rate	$54,272.69
Max. Negotiated Rate	$111,754.93
Rate for Payer: AlohaCare Medicare	$54,272.69
Rate for Payer: Hawaii Medical Service Association Commercial	$111,754.93
Rate for Payer: Hawaii Medical Service Association Medicare	$54,272.69
Rate for Payer: Humana Medicare	$54,272.69
Rate for Payer: Kaiser Permanente Medicare	$54,272.69
Rate for Payer: Ohana Health Plan Medicare	$54,272.69
Rate for Payer: UnitedHealthcare Medicare	$54,272.69

CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$97,201.90

Service Code	MSDRG 235
Min. Negotiated Rate	$58,272.99
Max. Negotiated Rate	$97,201.90
Rate for Payer: AlohaCare Medicare	$58,272.99
Rate for Payer: Hawaii Medical Service Association Commercial	$97,201.90
Rate for Payer: Hawaii Medical Service Association Medicare	$58,272.99
Rate for Payer: Humana Medicare	$58,272.99
Rate for Payer: Kaiser Permanente Medicare	$58,272.99
Rate for Payer: Ohana Health Plan Medicare	$58,272.99
Rate for Payer: UnitedHealthcare Medicare	$58,272.99

CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$90,375.73

Service Code	MSDRG 236
Min. Negotiated Rate	$41,717.95
Max. Negotiated Rate	$90,375.73
Rate for Payer: AlohaCare Medicare	$41,717.95
Rate for Payer: Hawaii Medical Service Association Commercial	$90,375.73
Rate for Payer: Hawaii Medical Service Association Medicare	$41,717.95
Rate for Payer: Humana Medicare	$41,717.95
Rate for Payer: Kaiser Permanente Medicare	$41,717.95
Rate for Payer: Ohana Health Plan Medicare	$41,717.95
Rate for Payer: UnitedHealthcare Medicare	$41,717.95

Know your out-of-pocket cost for care.

All Charges