Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Urinalysis Macroscopic Reflex Microscopic FSI

Facility

$41.00

Service Code	HCPCS 81000
Hospital Charge Code	8118073
Hospital Revenue Code	307
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$39.77
Rate for Payer: AlohaCare Medicaid	$20.50
Rate for Payer: AlohaCare Medicare	$20.50
Rate for Payer: Cash Price	$26.65
Rate for Payer: Cash Price	$26.65
Rate for Payer: Devoted Health Medicare	$22.55
Rate for Payer: Hawaii Medical Service Association ABD	$4.37
Rate for Payer: Hawaii Medical Service Association Commercial	$5.03
Rate for Payer: Hawaii Medical Service Association Medicare	$20.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.59
Rate for Payer: Hawaii Western Management Group Commercial	$4.02
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: Humana Medicare	$20.50
Rate for Payer: Kaiser Permanente Commercial	$36.90
Rate for Payer: Kaiser Permanente Medicaid	$20.91
Rate for Payer: Kaiser Permanente Medicare	$20.50
Rate for Payer: MDX Hawaii PPO	$39.77
Rate for Payer: Ohana Health Plan Medicaid	$20.50
Rate for Payer: Ohana Health Plan Medicare	$20.50
Rate for Payer: UnitedHealthcare Medicaid	$4.37
Rate for Payer: UnitedHealthcare Medicare	$20.50
Rate for Payer: University Health Alliance Commercial	$8.20

Urinalysis Macroscopic Reflex Microscopic FSI

Facility

$41.00

Service Code	HCPCS 81000
Hospital Charge Code	8118073
Hospital Revenue Code	307
Min. Negotiated Rate	$34.85
Max. Negotiated Rate	$39.77
Rate for Payer: Cash Price	$26.65
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: Kaiser Permanente Commercial	$36.90
Rate for Payer: MDX Hawaii PPO	$39.77

Urinalysis Macroscopic Reflex Microscropic and Culture/Sensitivity FSI

Facility

$43.00

Service Code	HCPCS 81015
Hospital Charge Code	8118074
Hospital Revenue Code	307
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$27.95
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: MDX Hawaii PPO	$41.71

Urinalysis Macroscopic Reflex Microscropic and Culture/Sensitivity FSI

Facility

$43.00

Service Code	HCPCS 81015
Hospital Charge Code	8118074
Hospital Revenue Code	307
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$41.71
Rate for Payer: AlohaCare Medicaid	$21.50
Rate for Payer: AlohaCare Medicare	$21.50
Rate for Payer: Cash Price	$27.95
Rate for Payer: Cash Price	$27.95
Rate for Payer: Devoted Health Medicare	$23.65
Rate for Payer: Hawaii Medical Service Association ABD	$4.20
Rate for Payer: Hawaii Medical Service Association Commercial	$3.81
Rate for Payer: Hawaii Medical Service Association Medicare	$21.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.41
Rate for Payer: Hawaii Western Management Group Commercial	$3.05
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Humana Medicare	$21.50
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: Kaiser Permanente Medicare	$21.50
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: Ohana Health Plan Medicaid	$21.50
Rate for Payer: Ohana Health Plan Medicare	$21.50
Rate for Payer: UnitedHealthcare Medicaid	$4.20
Rate for Payer: UnitedHealthcare Medicare	$21.50
Rate for Payer: University Health Alliance Commercial	$7.84

Urinalysis Microscopic FSI

Facility

$43.00

Service Code	HCPCS 81015
Hospital Charge Code	8404426
Hospital Revenue Code	307
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$27.95
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: MDX Hawaii PPO	$41.71

Urinalysis Microscopic FSI

Facility

$43.00

Service Code	HCPCS 81015
Hospital Charge Code	8404426
Hospital Revenue Code	307
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$41.71
Rate for Payer: AlohaCare Medicaid	$21.50
Rate for Payer: AlohaCare Medicare	$21.50
Rate for Payer: Cash Price	$27.95
Rate for Payer: Cash Price	$27.95
Rate for Payer: Devoted Health Medicare	$23.65
Rate for Payer: Hawaii Medical Service Association ABD	$4.20
Rate for Payer: Hawaii Medical Service Association Commercial	$3.81
Rate for Payer: Hawaii Medical Service Association Medicare	$21.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.41
Rate for Payer: Hawaii Western Management Group Commercial	$3.05
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Humana Medicare	$21.50
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: Kaiser Permanente Medicare	$21.50
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: Ohana Health Plan Medicaid	$21.50
Rate for Payer: Ohana Health Plan Medicare	$21.50
Rate for Payer: UnitedHealthcare Medicaid	$4.20
Rate for Payer: UnitedHealthcare Medicare	$21.50
Rate for Payer: University Health Alliance Commercial	$7.84

Urinary Catheter Insertion

Facility

$438.00

Service Code	HCPCS 51702
Hospital Charge Code	617589
Hospital Revenue Code	761
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$424.86
Rate for Payer: Cash Price	$284.70
Rate for Payer: AlohaCare Medicaid	$219.00
Rate for Payer: AlohaCare Medicare	$219.00
Rate for Payer: Cash Price	$284.70
Rate for Payer: Devoted Health Medicare	$240.90
Rate for Payer: Hawaii Medical Service Association Commercial	$169.91
Rate for Payer: Hawaii Medical Service Association Medicare	$219.00
Rate for Payer: Hawaii Western Management Group Commercial	$416.10
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Humana Medicare	$219.00
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: Kaiser Permanente Medicaid	$223.38
Rate for Payer: Kaiser Permanente Medicare	$219.00
Rate for Payer: MDX Hawaii PPO	$424.86
Rate for Payer: Ohana Health Plan Medicaid	$219.00
Rate for Payer: Ohana Health Plan Medicare	$219.00
Rate for Payer: UnitedHealthcare Medicaid	$21.90
Rate for Payer: UnitedHealthcare Medicare	$219.00
Rate for Payer: University Health Alliance Commercial	$319.26

Urinary Catheter Insertion

Facility

$438.00

Service Code	HCPCS 51702
Hospital Charge Code	617589
Hospital Revenue Code	761
Min. Negotiated Rate	$372.30
Max. Negotiated Rate	$424.86
Rate for Payer: Cash Price	$284.70
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: MDX Hawaii PPO	$424.86

URINARY STONES WITH MCC

Facility

$13,487.38

Service Code	MSDRG 693
Min. Negotiated Rate	$13,487.38
Max. Negotiated Rate	$13,487.38
Rate for Payer: Hawaii Medical Service Association Commercial	$13,487.38

URINARY STONES WITHOUT MCC

Facility

$12,595.02

Service Code	MSDRG 694
Min. Negotiated Rate	$12,595.02
Max. Negotiated Rate	$12,595.02
Rate for Payer: Hawaii Medical Service Association Commercial	$12,595.02

.Urine Cocaine Confirmation FSI

Facility

$231.00

Service Code	HCPCS 80353
Hospital Charge Code	8728212
Hospital Revenue Code	301
Min. Negotiated Rate	$196.35
Max. Negotiated Rate	$224.07
Rate for Payer: Cash Price	$150.15
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: MDX Hawaii PPO	$224.07

.Urine Cocaine Confirmation FSI

Facility

$231.00

Service Code	HCPCS 80353
Hospital Charge Code	8728212
Hospital Revenue Code	301
Min. Negotiated Rate	$21.67
Max. Negotiated Rate	$224.07
Rate for Payer: AlohaCare Medicaid	$115.50
Rate for Payer: AlohaCare Medicare	$115.50
Rate for Payer: Cash Price	$150.15
Rate for Payer: Cash Price	$150.15
Rate for Payer: Devoted Health Medicare	$127.05
Rate for Payer: Hawaii Medical Service Association ABD	$21.67
Rate for Payer: Hawaii Medical Service Association Medicare	$115.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.76
Rate for Payer: Hawaii Western Management Group Commercial	$219.45
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Humana Medicare	$115.50
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: Kaiser Permanente Medicaid	$117.81
Rate for Payer: Kaiser Permanente Medicare	$115.50
Rate for Payer: MDX Hawaii PPO	$224.07
Rate for Payer: Ohana Health Plan Medicaid	$115.50
Rate for Payer: Ohana Health Plan Medicare	$115.50
Rate for Payer: UnitedHealthcare Medicare	$115.50
Rate for Payer: University Health Alliance Commercial	$168.38

Urine Culture FSI

Facility

$100.00

Service Code	HCPCS 87086
Hospital Charge Code	8118075
Hospital Revenue Code	306
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Kaiser Permanente Commercial	$90.00
Rate for Payer: MDX Hawaii PPO	$97.00

Urine Culture FSI

Facility

$100.00

Service Code	HCPCS 87086
Hospital Charge Code	8118075
Hospital Revenue Code	306
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$97.00
Rate for Payer: AlohaCare Medicaid	$50.00
Rate for Payer: AlohaCare Medicare	$50.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Devoted Health Medicare	$55.00
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.09
Rate for Payer: Hawaii Medical Service Association Medicare	$50.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.72
Rate for Payer: Hawaii Western Management Group Commercial	$8.07
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Humana Medicare	$50.00
Rate for Payer: Kaiser Permanente Commercial	$90.00
Rate for Payer: Kaiser Permanente Medicaid	$51.00
Rate for Payer: Kaiser Permanente Medicare	$50.00
Rate for Payer: MDX Hawaii PPO	$97.00
Rate for Payer: Ohana Health Plan Medicaid	$50.00
Rate for Payer: Ohana Health Plan Medicare	$50.00
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$50.00
Rate for Payer: University Health Alliance Commercial	$20.87

Urine Dipstick POC

Facility

$35.00

Service Code	HCPCS 81002
Hospital Charge Code	607611
Hospital Revenue Code	307
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$22.75
Rate for Payer: Health Management Network Commercial	$29.75
Rate for Payer: Kaiser Permanente Commercial	$31.50
Rate for Payer: MDX Hawaii PPO	$33.95

Urine Dipstick POC

Facility

$35.00

Service Code	HCPCS 81002
Hospital Charge Code	607611
Hospital Revenue Code	307
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$33.95
Rate for Payer: AlohaCare Medicaid	$17.50
Rate for Payer: AlohaCare Medicare	$17.50
Rate for Payer: Cash Price	$22.75
Rate for Payer: Cash Price	$22.75
Rate for Payer: Devoted Health Medicare	$19.25
Rate for Payer: Hawaii Medical Service Association ABD	$3.54
Rate for Payer: Hawaii Medical Service Association Commercial	$4.35
Rate for Payer: Hawaii Medical Service Association Medicare	$17.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.72
Rate for Payer: Hawaii Western Management Group Commercial	$3.48
Rate for Payer: Health Management Network Commercial	$29.75
Rate for Payer: Humana Medicare	$17.50
Rate for Payer: Kaiser Permanente Commercial	$31.50
Rate for Payer: Kaiser Permanente Medicaid	$17.85
Rate for Payer: Kaiser Permanente Medicare	$17.50
Rate for Payer: MDX Hawaii PPO	$33.95
Rate for Payer: Ohana Health Plan Medicaid	$17.50
Rate for Payer: Ohana Health Plan Medicare	$17.50
Rate for Payer: UnitedHealthcare Medicaid	$3.54
Rate for Payer: UnitedHealthcare Medicare	$17.50
Rate for Payer: University Health Alliance Commercial	$6.60

Urine Dipstick POCT

Facility

$25.00

Service Code	HCPCS 81002
Hospital Charge Code	9841869
Hospital Revenue Code	307
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$24.25
Rate for Payer: Kaiser Permanente Medicare	$12.50
Rate for Payer: AlohaCare Medicaid	$12.50
Rate for Payer: AlohaCare Medicare	$12.50
Rate for Payer: Cash Price	$16.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Devoted Health Medicare	$13.75
Rate for Payer: Hawaii Medical Service Association ABD	$3.54
Rate for Payer: Hawaii Medical Service Association Commercial	$4.35
Rate for Payer: Hawaii Medical Service Association Medicare	$12.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.72
Rate for Payer: Hawaii Western Management Group Commercial	$3.48
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Humana Medicare	$12.50
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: Kaiser Permanente Medicaid	$12.75
Rate for Payer: MDX Hawaii PPO	$24.25
Rate for Payer: Ohana Health Plan Medicaid	$12.50
Rate for Payer: Ohana Health Plan Medicare	$12.50
Rate for Payer: UnitedHealthcare Medicaid	$3.54
Rate for Payer: UnitedHealthcare Medicare	$12.50
Rate for Payer: University Health Alliance Commercial	$6.60

Urine Dipstick POCT

Facility

$25.00

Service Code	HCPCS 81002
Hospital Charge Code	9841869
Hospital Revenue Code	307
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: MDX Hawaii PPO	$24.25

Urine Drug Abuse Screen

Facility

$154.00

Service Code	HCPCS 80305 QW
Hospital Charge Code	12514270
Hospital Revenue Code	301
Min. Negotiated Rate	$8.98
Max. Negotiated Rate	$149.38
Rate for Payer: AlohaCare Medicaid	$77.00
Rate for Payer: AlohaCare Medicare	$77.00
Rate for Payer: Cash Price	$100.10
Rate for Payer: Cash Price	$100.10
Rate for Payer: Devoted Health Medicare	$84.70
Rate for Payer: Hawaii Medical Service Association ABD	$19.03
Rate for Payer: Hawaii Medical Service Association Commercial	$15.75
Rate for Payer: Hawaii Medical Service Association Medicare	$77.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.11
Rate for Payer: Hawaii Western Management Group Commercial	$12.60
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Humana Medicare	$77.00
Rate for Payer: Kaiser Permanente Commercial	$138.60
Rate for Payer: Kaiser Permanente Medicaid	$78.54
Rate for Payer: Kaiser Permanente Medicare	$77.00
Rate for Payer: MDX Hawaii PPO	$149.38
Rate for Payer: Ohana Health Plan Medicaid	$77.00
Rate for Payer: Ohana Health Plan Medicare	$77.00
Rate for Payer: UnitedHealthcare Medicaid	$8.98
Rate for Payer: UnitedHealthcare Medicare	$77.00
Rate for Payer: University Health Alliance Commercial	$27.68

Urine Drug Abuse Screen

Facility

$154.00

Service Code	HCPCS 80305 QW
Hospital Charge Code	12514270
Hospital Revenue Code	301
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$149.38
Rate for Payer: Cash Price	$100.10
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Kaiser Permanente Commercial	$138.60
Rate for Payer: MDX Hawaii PPO	$149.38

Urine Drug Abuse Screen FSI

Facility

$1,384.00

Service Code	HCPCS 80307
Hospital Charge Code	8228936
Hospital Revenue Code	301
Min. Negotiated Rate	$1,176.40
Max. Negotiated Rate	$1,342.48
Rate for Payer: Cash Price	$899.60
Rate for Payer: Health Management Network Commercial	$1,176.40
Rate for Payer: Kaiser Permanente Commercial	$1,245.60
Rate for Payer: MDX Hawaii PPO	$1,342.48

Urine Drug Abuse Screen FSI

Facility

$1,384.00

Service Code	HCPCS 80307
Hospital Charge Code	8228936
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$1,342.48
Rate for Payer: AlohaCare Medicaid	$692.00
Rate for Payer: AlohaCare Medicare	$692.00
Rate for Payer: Cash Price	$899.60
Rate for Payer: Cash Price	$899.60
Rate for Payer: Devoted Health Medicare	$761.20
Rate for Payer: Hawaii Medical Service Association ABD	$59.38
Rate for Payer: Hawaii Medical Service Association Commercial	$77.67
Rate for Payer: Hawaii Medical Service Association Medicare	$692.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.38
Rate for Payer: Hawaii Western Management Group Commercial	$62.14
Rate for Payer: Health Management Network Commercial	$1,176.40
Rate for Payer: Humana Medicare	$692.00
Rate for Payer: Kaiser Permanente Commercial	$1,245.60
Rate for Payer: Kaiser Permanente Medicaid	$705.84
Rate for Payer: Kaiser Permanente Medicare	$692.00
Rate for Payer: MDX Hawaii PPO	$1,342.48
Rate for Payer: Ohana Health Plan Medicaid	$692.00
Rate for Payer: Ohana Health Plan Medicare	$692.00
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$692.00
Rate for Payer: University Health Alliance Commercial	$147.65

Urine Drug Screen FSI

Facility

$153.00

Service Code	HCPCS 80305 QW
Hospital Charge Code	8128158
Hospital Revenue Code	301
Min. Negotiated Rate	$8.98
Max. Negotiated Rate	$148.41
Rate for Payer: AlohaCare Medicaid	$76.50
Rate for Payer: AlohaCare Medicare	$76.50
Rate for Payer: Cash Price	$99.45
Rate for Payer: Cash Price	$99.45
Rate for Payer: Devoted Health Medicare	$84.15
Rate for Payer: Hawaii Medical Service Association ABD	$19.03
Rate for Payer: Hawaii Medical Service Association Commercial	$15.75
Rate for Payer: Hawaii Medical Service Association Medicare	$76.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.11
Rate for Payer: Hawaii Western Management Group Commercial	$12.60
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Humana Medicare	$76.50
Rate for Payer: Kaiser Permanente Commercial	$137.70
Rate for Payer: Kaiser Permanente Medicaid	$78.03
Rate for Payer: Kaiser Permanente Medicare	$76.50
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: Ohana Health Plan Medicaid	$76.50
Rate for Payer: Ohana Health Plan Medicare	$76.50
Rate for Payer: UnitedHealthcare Medicaid	$8.98
Rate for Payer: UnitedHealthcare Medicare	$76.50
Rate for Payer: University Health Alliance Commercial	$27.68

Urine Drug Screen FSI

Facility

$153.00

Service Code	HCPCS 80305 QW
Hospital Charge Code	8128158
Hospital Revenue Code	301
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$99.45
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Kaiser Permanente Commercial	$137.70
Rate for Payer: MDX Hawaii PPO	$148.41

Urine Oxycodone Scrn FSI

Facility

$1,384.00

Service Code	HCPCS 80307
Hospital Charge Code	8404560
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$1,342.48
Rate for Payer: AlohaCare Medicaid	$692.00
Rate for Payer: AlohaCare Medicare	$692.00
Rate for Payer: Cash Price	$899.60
Rate for Payer: Cash Price	$899.60
Rate for Payer: Devoted Health Medicare	$761.20
Rate for Payer: Hawaii Medical Service Association ABD	$59.38
Rate for Payer: Hawaii Medical Service Association Commercial	$77.67
Rate for Payer: Hawaii Medical Service Association Medicare	$692.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.38
Rate for Payer: Hawaii Western Management Group Commercial	$62.14
Rate for Payer: Health Management Network Commercial	$1,176.40
Rate for Payer: Humana Medicare	$692.00
Rate for Payer: Kaiser Permanente Commercial	$1,245.60
Rate for Payer: Kaiser Permanente Medicaid	$705.84
Rate for Payer: Kaiser Permanente Medicare	$692.00
Rate for Payer: MDX Hawaii PPO	$1,342.48
Rate for Payer: Ohana Health Plan Medicaid	$692.00
Rate for Payer: Ohana Health Plan Medicare	$692.00
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$692.00
Rate for Payer: University Health Alliance Commercial	$147.65

Know your out-of-pocket cost for care.

All Charges