Kau Hospital

All Charges

Charge

Type

Setting

Price

UREA 15 GRAM ORAL POWDER PACKET [137170]

Facility

$16.00

Service Code	NDC 00011000000
Hospital Revenue Code	637
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$15.52
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$4.96
Rate for Payer: Cash Price	$9.60
Rate for Payer: Devoted Health Medicare	$5.44
Rate for Payer: Hawaii Medical Service Association Medicare	$4.96
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Humana Medicare	$4.96
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$4.96
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$4.96
Rate for Payer: Ohana Health Plan Medicare	$4.96
Rate for Payer: UnitedHealthcare Medicare	$4.96
Rate for Payer: University Health Alliance Commercial	$11.66

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

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

UROMAX CATH KIT M0062251210

Facility

$938.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$797.30
Max. Negotiated Rate	$909.86
Rate for Payer: Cash Price	$562.80
Rate for Payer: Health Management Network Commercial	$797.30
Rate for Payer: Kaiser Permanente Commercial	$844.20
Rate for Payer: MDX Hawaii PPO	$909.86

UROMAX CATH KIT M0062251210

Facility

$938.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$290.78
Max. Negotiated Rate	$909.86
Rate for Payer: AlohaCare Medicaid	$469.00
Rate for Payer: AlohaCare Medicare	$290.78
Rate for Payer: Cash Price	$562.80
Rate for Payer: Devoted Health Medicare	$318.92
Rate for Payer: Hawaii Medical Service Association Medicare	$290.78
Rate for Payer: Hawaii Western Management Group Commercial	$891.10
Rate for Payer: Health Management Network Commercial	$797.30
Rate for Payer: Humana Medicare	$290.78
Rate for Payer: Kaiser Permanente Commercial	$844.20
Rate for Payer: Kaiser Permanente Medicaid	$478.38
Rate for Payer: Kaiser Permanente Medicare	$290.78
Rate for Payer: MDX Hawaii PPO	$909.86
Rate for Payer: Ohana Health Plan Medicaid	$290.78
Rate for Payer: Ohana Health Plan Medicare	$290.78
Rate for Payer: UnitedHealthcare Medicare	$290.78
Rate for Payer: University Health Alliance Commercial	$683.71

UROMAX ULTRA BALLOON KIT

Facility

$883.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$273.73
Max. Negotiated Rate	$856.51
Rate for Payer: AlohaCare Medicaid	$441.50
Rate for Payer: AlohaCare Medicare	$273.73
Rate for Payer: Cash Price	$529.80
Rate for Payer: Devoted Health Medicare	$300.22
Rate for Payer: Hawaii Medical Service Association Medicare	$273.73
Rate for Payer: Hawaii Western Management Group Commercial	$838.85
Rate for Payer: Health Management Network Commercial	$750.55
Rate for Payer: Humana Medicare	$273.73
Rate for Payer: Kaiser Permanente Commercial	$794.70
Rate for Payer: Kaiser Permanente Medicaid	$450.33
Rate for Payer: Kaiser Permanente Medicare	$273.73
Rate for Payer: MDX Hawaii PPO	$856.51
Rate for Payer: Ohana Health Plan Medicaid	$273.73
Rate for Payer: Ohana Health Plan Medicare	$273.73
Rate for Payer: UnitedHealthcare Medicare	$273.73
Rate for Payer: University Health Alliance Commercial	$643.62

UROMAX ULTRA BALLOON KIT

Facility

$883.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$750.55
Max. Negotiated Rate	$856.51
Rate for Payer: Cash Price	$529.80
Rate for Payer: Health Management Network Commercial	$750.55
Rate for Payer: Kaiser Permanente Commercial	$794.70
Rate for Payer: MDX Hawaii PPO	$856.51

URSODIOL 300 MG CAPSULE [11624]

Facility

$23.00

Service Code	NDC 60687010001
Hospital Revenue Code	250
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$13.80
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: MDX Hawaii PPO	$22.31

URSODIOL 300 MG CAPSULE [11624]

Facility

$23.00

Service Code	NDC 60687010011
Hospital Revenue Code	637
Min. Negotiated Rate	$7.13
Max. Negotiated Rate	$22.31
Rate for Payer: AlohaCare Medicaid	$11.50
Rate for Payer: AlohaCare Medicare	$7.13
Rate for Payer: Cash Price	$13.80
Rate for Payer: Devoted Health Medicare	$7.82
Rate for Payer: Hawaii Medical Service Association Medicare	$7.13
Rate for Payer: Hawaii Western Management Group Commercial	$21.85
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Humana Medicare	$7.13
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: Kaiser Permanente Medicare	$7.13
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: Ohana Health Plan Medicaid	$7.13
Rate for Payer: Ohana Health Plan Medicare	$7.13
Rate for Payer: UnitedHealthcare Medicare	$7.13
Rate for Payer: University Health Alliance Commercial	$16.76

URSODIOL 300 MG CAPSULE [11624]

Facility

$23.00

Service Code	NDC 60687010011
Hospital Revenue Code	250
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$13.80
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: MDX Hawaii PPO	$22.31

URSODIOL 300 MG CAPSULE [11624]

Facility

$23.00

Service Code	NDC 60687010001
Hospital Revenue Code	637
Min. Negotiated Rate	$7.13
Max. Negotiated Rate	$22.31
Rate for Payer: AlohaCare Medicaid	$11.50
Rate for Payer: AlohaCare Medicare	$7.13
Rate for Payer: Cash Price	$13.80
Rate for Payer: Devoted Health Medicare	$7.82
Rate for Payer: Hawaii Medical Service Association Medicare	$7.13
Rate for Payer: Hawaii Western Management Group Commercial	$21.85
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Humana Medicare	$7.13
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: Kaiser Permanente Medicare	$7.13
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: Ohana Health Plan Medicaid	$7.13
Rate for Payer: Ohana Health Plan Medicare	$7.13
Rate for Payer: UnitedHealthcare Medicare	$7.13
Rate for Payer: University Health Alliance Commercial	$16.76

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC

Facility

$22,279.88

Service Code	MSDRG 742
Min. Negotiated Rate	$22,279.88
Max. Negotiated Rate	$22,279.88
Rate for Payer: Hawaii Medical Service Association Commercial	$22,279.88

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC

Facility

$20,028.19

Service Code	MSDRG 743
Min. Negotiated Rate	$20,028.19
Max. Negotiated Rate	$20,028.19
Rate for Payer: Hawaii Medical Service Association Commercial	$20,028.19

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC

Facility

$36,074.44

Service Code	MSDRG 740
Min. Negotiated Rate	$36,074.44
Max. Negotiated Rate	$36,074.44
Rate for Payer: Hawaii Medical Service Association Commercial	$36,074.44

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC

Facility

$37,496.56

Service Code	MSDRG 739
Min. Negotiated Rate	$37,496.56
Max. Negotiated Rate	$37,496.56
Rate for Payer: Hawaii Medical Service Association Commercial	$37,496.56

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$25,835.18

Service Code	MSDRG 741
Min. Negotiated Rate	$25,835.18
Max. Negotiated Rate	$25,835.18
Rate for Payer: Hawaii Medical Service Association Commercial	$25,835.18

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC

Facility

$45,626.35

Service Code	MSDRG 737
Min. Negotiated Rate	$45,626.35
Max. Negotiated Rate	$45,626.35
Rate for Payer: Hawaii Medical Service Association Commercial	$45,626.35

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC

Facility

$45,626.35

Service Code	MSDRG 736
Min. Negotiated Rate	$45,626.35
Max. Negotiated Rate	$45,626.35
Rate for Payer: Hawaii Medical Service Association Commercial	$45,626.35

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$45,626.35

Service Code	MSDRG 738
Min. Negotiated Rate	$45,626.35
Max. Negotiated Rate	$45,626.35
Rate for Payer: Hawaii Medical Service Association Commercial	$45,626.35

UTERINE MANIPULATOR

Facility

$568.00

Hospital Revenue Code	272
Min. Negotiated Rate	$482.80
Max. Negotiated Rate	$550.96
Rate for Payer: Cash Price	$340.80
Rate for Payer: Health Management Network Commercial	$482.80
Rate for Payer: Kaiser Permanente Commercial	$511.20
Rate for Payer: MDX Hawaii PPO	$550.96

UTERINE MANIPULATOR

Facility

$568.00

Hospital Revenue Code	272
Min. Negotiated Rate	$176.08
Max. Negotiated Rate	$550.96
Rate for Payer: AlohaCare Medicaid	$284.00
Rate for Payer: AlohaCare Medicare	$176.08
Rate for Payer: Cash Price	$340.80
Rate for Payer: Devoted Health Medicare	$193.12
Rate for Payer: Hawaii Medical Service Association Medicare	$176.08
Rate for Payer: Hawaii Western Management Group Commercial	$539.60
Rate for Payer: Health Management Network Commercial	$482.80
Rate for Payer: Humana Medicare	$176.08
Rate for Payer: Kaiser Permanente Commercial	$511.20
Rate for Payer: Kaiser Permanente Medicaid	$289.68
Rate for Payer: Kaiser Permanente Medicare	$176.08
Rate for Payer: MDX Hawaii PPO	$550.96
Rate for Payer: Ohana Health Plan Medicaid	$176.08
Rate for Payer: Ohana Health Plan Medicare	$176.08
Rate for Payer: UnitedHealthcare Medicare	$176.08
Rate for Payer: University Health Alliance Commercial	$414.02

VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC

Facility

$26,451.43

Service Code	MSDRG 746
Min. Negotiated Rate	$26,451.43
Max. Negotiated Rate	$26,451.43
Rate for Payer: Hawaii Medical Service Association Commercial	$26,451.43

Know your out-of-pocket cost for care.

All Charges