Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

urea 15 g REC packet [KMC]

Facility

$17.40

Service Code	NDC 62530000011
Hospital Revenue Code	250
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$16.88
Rate for Payer: AlohaCare Medicaid	$8.70
Rate for Payer: AlohaCare Medicare	$7.31
Rate for Payer: Cash Price	$11.31
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$16.01
Rate for Payer: Devoted Health Medicare	$7.31
Rate for Payer: Hawaii Medical Service Association Medicare	$7.31
Rate for Payer: Hawaii Western Management Group Commercial	$16.53
Rate for Payer: Health Management Network Commercial	$14.79
Rate for Payer: Humana Medicare	$7.31
Rate for Payer: Kaiser Permanente Commercial	$15.66
Rate for Payer: Kaiser Permanente Medicaid	$8.87
Rate for Payer: Kaiser Permanente Medicare	$7.31
Rate for Payer: MDX Hawaii PPO	$16.88
Rate for Payer: Ohana Health Plan Medicaid	$7.31
Rate for Payer: Ohana Health Plan Medicare	$7.31
Rate for Payer: UnitedHealthcare Medicaid	$10.44
Rate for Payer: UnitedHealthcare Medicare	$7.31
Rate for Payer: University Health Alliance Commercial	$12.68

urea 15 g REC packet [KMC]

Facility

$17.40

Service Code	NDC 62530000011
Hospital Revenue Code	250
Min. Negotiated Rate	$14.79
Max. Negotiated Rate	$16.88
Rate for Payer: Cash Price	$11.31
Rate for Payer: Health Management Network Commercial	$14.79
Rate for Payer: Kaiser Permanente Commercial	$15.66
Rate for Payer: MDX Hawaii PPO	$16.88

urea 40% topical Cream [KMC]

Facility

$3.23

Service Code	NDC 67877027203
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$3.13
Rate for Payer: AlohaCare Medicaid	$1.61
Rate for Payer: AlohaCare Medicare	$1.36
Rate for Payer: Cash Price	$2.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.97
Rate for Payer: Devoted Health Medicare	$1.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1.36
Rate for Payer: Hawaii Western Management Group Commercial	$3.07
Rate for Payer: Health Management Network Commercial	$2.75
Rate for Payer: Humana Medicare	$1.36
Rate for Payer: Kaiser Permanente Commercial	$2.91
Rate for Payer: Kaiser Permanente Medicaid	$1.65
Rate for Payer: Kaiser Permanente Medicare	$1.36
Rate for Payer: MDX Hawaii PPO	$3.13
Rate for Payer: Ohana Health Plan Medicaid	$1.36
Rate for Payer: Ohana Health Plan Medicare	$1.36
Rate for Payer: UnitedHealthcare Medicaid	$1.94
Rate for Payer: UnitedHealthcare Medicare	$1.36
Rate for Payer: University Health Alliance Commercial	$2.35

urea 40% topical Cream [KMC]

Facility

$3.23

Service Code	NDC 67877027203
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$3.13
Rate for Payer: Cash Price	$2.10
Rate for Payer: Health Management Network Commercial	$2.75
Rate for Payer: Kaiser Permanente Commercial	$2.91
Rate for Payer: MDX Hawaii PPO	$3.13

Urea Topical 10% [KMC]

Facility

$0.16

Service Code	NDC 58980060880
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: AlohaCare Medicaid	$0.08
Rate for Payer: AlohaCare Medicare	$0.07
Rate for Payer: Cash Price	$0.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.15
Rate for Payer: Devoted Health Medicare	$0.07
Rate for Payer: Hawaii Medical Service Association Medicare	$0.07
Rate for Payer: Hawaii Western Management Group Commercial	$0.15
Rate for Payer: Health Management Network Commercial	$0.14
Rate for Payer: Humana Medicare	$0.07
Rate for Payer: Kaiser Permanente Commercial	$0.14
Rate for Payer: Kaiser Permanente Medicaid	$0.08
Rate for Payer: Kaiser Permanente Medicare	$0.07
Rate for Payer: MDX Hawaii PPO	$0.16
Rate for Payer: Ohana Health Plan Medicaid	$0.07
Rate for Payer: Ohana Health Plan Medicare	$0.07
Rate for Payer: UnitedHealthcare Medicaid	$0.10
Rate for Payer: UnitedHealthcare Medicare	$0.07
Rate for Payer: University Health Alliance Commercial	$0.12

Urea Topical 10% [KMC]

Facility

$0.16

Service Code	NDC 58980060880
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.16
Rate for Payer: Cash Price	$0.10
Rate for Payer: Health Management Network Commercial	$0.14
Rate for Payer: Kaiser Permanente Commercial	$0.14
Rate for Payer: MDX Hawaii PPO	$0.16

URETHRAL CATH TRAY

Facility

$47.00

Hospital Charge Code	8379
Hospital Revenue Code	272
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$30.55
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Kaiser Permanente Commercial	$42.30
Rate for Payer: MDX Hawaii PPO	$45.59

URETHRAL CATH TRAY

Facility

$47.00

Hospital Charge Code	8379
Hospital Revenue Code	272
Min. Negotiated Rate	$19.74
Max. Negotiated Rate	$45.59
Rate for Payer: AlohaCare Medicaid	$23.50
Rate for Payer: AlohaCare Medicare	$19.74
Rate for Payer: Cash Price	$30.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$43.24
Rate for Payer: Devoted Health Medicare	$19.74
Rate for Payer: Hawaii Medical Service Association Medicare	$19.74
Rate for Payer: Hawaii Western Management Group Commercial	$44.65
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Humana Medicare	$19.74
Rate for Payer: Kaiser Permanente Commercial	$42.30
Rate for Payer: Kaiser Permanente Medicaid	$23.97
Rate for Payer: Kaiser Permanente Medicare	$19.74
Rate for Payer: MDX Hawaii PPO	$45.59
Rate for Payer: Ohana Health Plan Medicaid	$19.74
Rate for Payer: Ohana Health Plan Medicare	$19.74
Rate for Payer: UnitedHealthcare Medicare	$19.74
Rate for Payer: University Health Alliance Commercial	$34.26

URETHRAL PROCEDURES WITH CC/MCC

Facility

$35,505.60

Service Code	MSDRG 671
Min. Negotiated Rate	$35,505.60
Max. Negotiated Rate	$35,505.60
Rate for Payer: Hawaii Medical Service Association Commercial	$35,505.60

URETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$35,505.60

Service Code	MSDRG 672
Min. Negotiated Rate	$35,505.60
Max. Negotiated Rate	$35,505.60
Rate for Payer: Hawaii Medical Service Association Commercial	$35,505.60

URETHRAL STRICTURE

Facility

$5,190.74

Service Code	MSDRG 697
Min. Negotiated Rate	$5,190.74
Max. Negotiated Rate	$5,190.74
Rate for Payer: Hawaii Medical Service Association Commercial	$5,190.74

Uric Acid

Facility

$89.00

Service Code	HCPCS 84550
Hospital Charge Code	422845500
Hospital Revenue Code	301
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$37.38
Rate for Payer: Cash Price	$57.85
Rate for Payer: Cash Price	$57.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$81.88
Rate for Payer: Devoted Health Medicare	$37.38
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$6.25
Rate for Payer: Hawaii Medical Service Association Commercial	$5.65
Rate for Payer: Hawaii Medical Service Association Medicare	$37.38
Rate for Payer: Hawaii Western Management Group Commercial	$4.52
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$37.38
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicare	$37.38
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$37.38
Rate for Payer: Ohana Health Plan Medicare	$37.38
Rate for Payer: UnitedHealthcare Medicaid	$6.25
Rate for Payer: UnitedHealthcare Medicare	$37.38
Rate for Payer: University Health Alliance Commercial	$11.67

Uric Acid

Facility

$89.00

Service Code	HCPCS 84550
Hospital Charge Code	422845500
Hospital Revenue Code	301
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$57.85
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33

Uric Acid DLS

Facility

$89.00

Service Code	HCPCS 84550
Hospital Charge Code	422845500
Hospital Revenue Code	301
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$37.38
Rate for Payer: Cash Price	$57.85
Rate for Payer: Cash Price	$57.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$81.88
Rate for Payer: Devoted Health Medicare	$37.38
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$6.25
Rate for Payer: Hawaii Medical Service Association Commercial	$5.65
Rate for Payer: Hawaii Medical Service Association Medicare	$37.38
Rate for Payer: Hawaii Western Management Group Commercial	$4.52
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$37.38
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicare	$37.38
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$37.38
Rate for Payer: Ohana Health Plan Medicare	$37.38
Rate for Payer: UnitedHealthcare Medicaid	$6.25
Rate for Payer: UnitedHealthcare Medicare	$37.38
Rate for Payer: University Health Alliance Commercial	$11.67

Uric Acid DLS

Facility

$89.00

Service Code	HCPCS 84550
Hospital Charge Code	422845500
Hospital Revenue Code	301
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$57.85
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33

Urinalysis Complete 5

Facility

$30.00

Service Code	HCPCS 81001
Hospital Charge Code	422810010
Hospital Revenue Code	307
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$19.50
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: MDX Hawaii PPO	$29.10

Urinalysis Complete 5

Facility

$30.00

Service Code	HCPCS 81001
Hospital Charge Code	422810010
Hospital Revenue Code	307
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$29.10
Rate for Payer: AlohaCare Medicaid	$15.00
Rate for Payer: AlohaCare Medicare	$12.60
Rate for Payer: Cash Price	$19.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$27.60
Rate for Payer: Devoted Health Medicare	$12.60
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$4.37
Rate for Payer: Hawaii Medical Service Association Commercial	$3.96
Rate for Payer: Hawaii Medical Service Association Medicare	$12.60
Rate for Payer: Hawaii Western Management Group Commercial	$3.17
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Humana Medicare	$12.60
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: Kaiser Permanente Medicaid	$15.30
Rate for Payer: Kaiser Permanente Medicare	$12.60
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: Ohana Health Plan Medicaid	$12.60
Rate for Payer: Ohana Health Plan Medicare	$12.60
Rate for Payer: UnitedHealthcare Medicaid	$4.37
Rate for Payer: UnitedHealthcare Medicare	$12.60
Rate for Payer: University Health Alliance Commercial	$8.20

Urinalysis w/ Reflex

Facility

$30.00

Service Code	HCPCS 81001
Hospital Charge Code	422810010
Hospital Revenue Code	307
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$19.50
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: MDX Hawaii PPO	$29.10

Urinalysis w/ Reflex

Facility

$30.00

Service Code	HCPCS 81001
Hospital Charge Code	422810010
Hospital Revenue Code	307
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$29.10
Rate for Payer: AlohaCare Medicaid	$15.00
Rate for Payer: AlohaCare Medicare	$12.60
Rate for Payer: Cash Price	$19.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$27.60
Rate for Payer: Devoted Health Medicare	$12.60
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$4.37
Rate for Payer: Hawaii Medical Service Association Commercial	$3.96
Rate for Payer: Hawaii Medical Service Association Medicare	$12.60
Rate for Payer: Hawaii Western Management Group Commercial	$3.17
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Humana Medicare	$12.60
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: Kaiser Permanente Medicaid	$15.30
Rate for Payer: Kaiser Permanente Medicare	$12.60
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: Ohana Health Plan Medicaid	$12.60
Rate for Payer: Ohana Health Plan Medicare	$12.60
Rate for Payer: UnitedHealthcare Medicaid	$4.37
Rate for Payer: UnitedHealthcare Medicare	$12.60
Rate for Payer: University Health Alliance Commercial	$8.20

URINARY DRAINAGE BAG W/ANTI REFLUX CHAMBER

Facility

$293.00

Hospital Charge Code	8381
Hospital Revenue Code	272
Min. Negotiated Rate	$123.06
Max. Negotiated Rate	$284.21
Rate for Payer: AlohaCare Medicaid	$146.50
Rate for Payer: AlohaCare Medicare	$123.06
Rate for Payer: Cash Price	$190.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$269.56
Rate for Payer: Devoted Health Medicare	$123.06
Rate for Payer: Hawaii Medical Service Association Medicare	$123.06
Rate for Payer: Hawaii Western Management Group Commercial	$278.35
Rate for Payer: Health Management Network Commercial	$249.05
Rate for Payer: Humana Medicare	$123.06
Rate for Payer: Kaiser Permanente Commercial	$263.70
Rate for Payer: Kaiser Permanente Medicaid	$149.43
Rate for Payer: Kaiser Permanente Medicare	$123.06
Rate for Payer: MDX Hawaii PPO	$284.21
Rate for Payer: Ohana Health Plan Medicaid	$123.06
Rate for Payer: Ohana Health Plan Medicare	$123.06
Rate for Payer: UnitedHealthcare Medicare	$123.06
Rate for Payer: University Health Alliance Commercial	$213.57

URINARY DRAINAGE BAG W/ANTI REFLUX CHAMBER

Facility

$293.00

Hospital Charge Code	8381
Hospital Revenue Code	272
Min. Negotiated Rate	$249.05
Max. Negotiated Rate	$284.21
Rate for Payer: Cash Price	$190.45
Rate for Payer: Health Management Network Commercial	$249.05
Rate for Payer: Kaiser Permanente Commercial	$263.70
Rate for Payer: MDX Hawaii PPO	$284.21

URINARY STONES WITH MCC

Facility

$12,538.36

Service Code	MSDRG 693
Min. Negotiated Rate	$12,538.36
Max. Negotiated Rate	$12,538.36
Rate for Payer: Hawaii Medical Service Association Commercial	$12,538.36

URINARY STONES WITHOUT MCC

Facility

$11,708.79

Service Code	MSDRG 694
Min. Negotiated Rate	$11,708.79
Max. Negotiated Rate	$11,708.79
Rate for Payer: Hawaii Medical Service Association Commercial	$11,708.79

Urine Culture DLS

Facility

$130.00

Service Code	HCPCS 87086
Hospital Charge Code	422870865
Hospital Revenue Code	306
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$126.10
Rate for Payer: AlohaCare Medicaid	$65.00
Rate for Payer: AlohaCare Medicare	$54.60
Rate for Payer: Cash Price	$84.50
Rate for Payer: Cash Price	$84.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$119.60
Rate for Payer: Devoted Health Medicare	$54.60
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.09
Rate for Payer: Hawaii Medical Service Association Medicare	$54.60
Rate for Payer: Hawaii Western Management Group Commercial	$8.07
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Humana Medicare	$54.60
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: Kaiser Permanente Medicaid	$66.30
Rate for Payer: Kaiser Permanente Medicare	$54.60
Rate for Payer: MDX Hawaii PPO	$126.10
Rate for Payer: Ohana Health Plan Medicaid	$54.60
Rate for Payer: Ohana Health Plan Medicare	$54.60
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$54.60
Rate for Payer: University Health Alliance Commercial	$20.87

Urine Culture DLS

Facility

$130.00

Service Code	HCPCS 87086
Hospital Charge Code	422870865
Hospital Revenue Code	306
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$84.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: MDX Hawaii PPO	$126.10

Know your out-of-pocket cost for care.

All Charges