Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Bill Only 83519 PTH-Related Protein

Facility

$208.00

Service Code	HCPCS 83519
Hospital Charge Code	13416124
Hospital Revenue Code	300
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$135.20
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: MDX Hawaii PPO	$201.76

Bill Only 83520 Glomerular Basement Membr Ab, Qnt

Facility

$156.00

Service Code	HCPCS 83520
Hospital Charge Code	13395384
Hospital Revenue Code	300
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$151.32
Rate for Payer: Cash Price	$101.40
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: Kaiser Permanente Commercial	$140.40
Rate for Payer: MDX Hawaii PPO	$151.32

Bill Only 83520 Glomerular Basement Membr Ab, Qnt

Facility

$156.00

Service Code	HCPCS 83520
Hospital Charge Code	13395384
Hospital Revenue Code	300
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$151.32
Rate for Payer: AlohaCare Medicaid	$78.00
Rate for Payer: AlohaCare Medicare	$78.00
Rate for Payer: Cash Price	$101.40
Rate for Payer: Cash Price	$101.40
Rate for Payer: Devoted Health Medicare	$85.80
Rate for Payer: Hawaii Medical Service Association ABD	$17.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21.59
Rate for Payer: Hawaii Medical Service Association Medicare	$78.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.78
Rate for Payer: Hawaii Western Management Group Commercial	$17.27
Rate for Payer: Health Management Network Commercial	$132.60
Rate for Payer: Humana Medicare	$78.00
Rate for Payer: Kaiser Permanente Commercial	$140.40
Rate for Payer: Kaiser Permanente Medicaid	$79.56
Rate for Payer: Kaiser Permanente Medicare	$78.00
Rate for Payer: MDX Hawaii PPO	$151.32
Rate for Payer: Ohana Health Plan Medicaid	$78.00
Rate for Payer: Ohana Health Plan Medicare	$78.00
Rate for Payer: UnitedHealthcare Medicaid	$17.89
Rate for Payer: UnitedHealthcare Medicare	$78.00
Rate for Payer: University Health Alliance Commercial	$33.47

Bill Only 83630 Lactoferrin, Qualitative, Stool

Facility

$49.00

Service Code	HCPCS 83630
Hospital Charge Code	13407407
Hospital Revenue Code	300
Min. Negotiated Rate	$16.45
Max. Negotiated Rate	$50.73
Rate for Payer: AlohaCare Medicaid	$24.50
Rate for Payer: AlohaCare Medicare	$24.50
Rate for Payer: Cash Price	$31.85
Rate for Payer: Cash Price	$31.85
Rate for Payer: Devoted Health Medicare	$26.95
Rate for Payer: Hawaii Medical Service Association ABD	$16.45
Rate for Payer: Hawaii Medical Service Association Commercial	$24.62
Rate for Payer: Hawaii Medical Service Association Medicare	$24.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.68
Rate for Payer: Hawaii Western Management Group Commercial	$19.70
Rate for Payer: Health Management Network Commercial	$41.65
Rate for Payer: Humana Medicare	$24.50
Rate for Payer: Kaiser Permanente Commercial	$44.10
Rate for Payer: Kaiser Permanente Medicaid	$24.99
Rate for Payer: Kaiser Permanente Medicare	$24.50
Rate for Payer: MDX Hawaii PPO	$47.53
Rate for Payer: Ohana Health Plan Medicaid	$24.50
Rate for Payer: Ohana Health Plan Medicare	$24.50
Rate for Payer: UnitedHealthcare Medicaid	$16.45
Rate for Payer: UnitedHealthcare Medicare	$24.50
Rate for Payer: University Health Alliance Commercial	$50.73

Bill Only 83630 Lactoferrin, Qualitative, Stool

Facility

$49.00

Service Code	HCPCS 83630
Hospital Charge Code	13407407
Hospital Revenue Code	300
Min. Negotiated Rate	$41.65
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$31.85
Rate for Payer: Health Management Network Commercial	$41.65
Rate for Payer: Kaiser Permanente Commercial	$44.10
Rate for Payer: MDX Hawaii PPO	$47.53

Bill Only 83735 Electrolyte & Osmolality Pnl, Fecal

Facility

$111.00

Service Code	HCPCS 83735
Hospital Charge Code	13395381
Hospital Revenue Code	300
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$107.67
Rate for Payer: AlohaCare Medicaid	$55.50
Rate for Payer: AlohaCare Medicare	$55.50
Rate for Payer: Cash Price	$72.15
Rate for Payer: Cash Price	$72.15
Rate for Payer: Devoted Health Medicare	$61.05
Rate for Payer: Hawaii Medical Service Association ABD	$9.26
Rate for Payer: Hawaii Medical Service Association Commercial	$8.38
Rate for Payer: Hawaii Medical Service Association Medicare	$55.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.72
Rate for Payer: Hawaii Western Management Group Commercial	$6.70
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Humana Medicare	$55.50
Rate for Payer: Kaiser Permanente Commercial	$99.90
Rate for Payer: Kaiser Permanente Medicaid	$56.61
Rate for Payer: Kaiser Permanente Medicare	$55.50
Rate for Payer: MDX Hawaii PPO	$107.67
Rate for Payer: Ohana Health Plan Medicaid	$55.50
Rate for Payer: Ohana Health Plan Medicare	$55.50
Rate for Payer: UnitedHealthcare Medicaid	$9.26
Rate for Payer: UnitedHealthcare Medicare	$55.50
Rate for Payer: University Health Alliance Commercial	$17.32

Bill Only 83735 Electrolyte & Osmolality Pnl, Fecal

Facility

$111.00

Service Code	HCPCS 83735
Hospital Charge Code	13395381
Hospital Revenue Code	300
Min. Negotiated Rate	$94.35
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$72.15
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Kaiser Permanente Commercial	$99.90
Rate for Payer: MDX Hawaii PPO	$107.67

Bill Only 83986 pH, Stool

Facility

$37.00

Service Code	HCPCS 83986
Hospital Charge Code	13407409
Hospital Revenue Code	300
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$35.89
Rate for Payer: AlohaCare Medicaid	$18.50
Rate for Payer: AlohaCare Medicare	$18.50
Rate for Payer: Cash Price	$24.05
Rate for Payer: Cash Price	$24.05
Rate for Payer: Devoted Health Medicare	$20.35
Rate for Payer: Hawaii Medical Service Association ABD	$4.95
Rate for Payer: Hawaii Medical Service Association Commercial	$4.47
Rate for Payer: Hawaii Medical Service Association Medicare	$18.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.20
Rate for Payer: Hawaii Western Management Group Commercial	$3.58
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Humana Medicare	$18.50
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: Kaiser Permanente Medicare	$18.50
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: Ohana Health Plan Medicaid	$18.50
Rate for Payer: Ohana Health Plan Medicare	$18.50
Rate for Payer: UnitedHealthcare Medicaid	$4.95
Rate for Payer: UnitedHealthcare Medicare	$18.50
Rate for Payer: University Health Alliance Commercial	$9.25

Bill Only 83986 pH, Stool

Facility

$37.00

Service Code	HCPCS 83986
Hospital Charge Code	13407409
Hospital Revenue Code	300
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$24.05
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: MDX Hawaii PPO	$35.89

Bill Only 83993 Calprotectin, Feces

Facility

$259.00

Service Code	HCPCS 83993
Hospital Charge Code	13416116
Hospital Revenue Code	300
Min. Negotiated Rate	$220.15
Max. Negotiated Rate	$251.23
Rate for Payer: Cash Price	$168.35
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: MDX Hawaii PPO	$251.23

Bill Only 83993 Calprotectin, Feces

Facility

$259.00

Service Code	HCPCS 83993
Hospital Charge Code	13416116
Hospital Revenue Code	300
Min. Negotiated Rate	$19.63
Max. Negotiated Rate	$251.23
Rate for Payer: AlohaCare Medicaid	$129.50
Rate for Payer: AlohaCare Medicare	$129.50
Rate for Payer: Cash Price	$168.35
Rate for Payer: Cash Price	$168.35
Rate for Payer: Devoted Health Medicare	$142.45
Rate for Payer: Hawaii Medical Service Association ABD	$27.42
Rate for Payer: Hawaii Medical Service Association Commercial	$24.54
Rate for Payer: Hawaii Medical Service Association Medicare	$129.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.11
Rate for Payer: Hawaii Western Management Group Commercial	$19.63
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Humana Medicare	$129.50
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: Kaiser Permanente Medicaid	$132.09
Rate for Payer: Kaiser Permanente Medicare	$129.50
Rate for Payer: MDX Hawaii PPO	$251.23
Rate for Payer: Ohana Health Plan Medicaid	$129.50
Rate for Payer: Ohana Health Plan Medicare	$129.50
Rate for Payer: UnitedHealthcare Medicaid	$27.42
Rate for Payer: UnitedHealthcare Medicare	$129.50
Rate for Payer: University Health Alliance Commercial	$50.73

Bill Only 86022 Serotonin Release Assay, LMWH

Facility

$317.00

Service Code	HCPCS 86022
Hospital Charge Code	13395391
Hospital Revenue Code	300
Min. Negotiated Rate	$18.37
Max. Negotiated Rate	$307.49
Rate for Payer: AlohaCare Medicaid	$158.50
Rate for Payer: AlohaCare Medicare	$158.50
Rate for Payer: Cash Price	$206.05
Rate for Payer: Cash Price	$206.05
Rate for Payer: Devoted Health Medicare	$174.35
Rate for Payer: Hawaii Medical Service Association ABD	$25.38
Rate for Payer: Hawaii Medical Service Association Commercial	$22.96
Rate for Payer: Hawaii Medical Service Association Medicare	$158.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.65
Rate for Payer: Hawaii Western Management Group Commercial	$18.37
Rate for Payer: Health Management Network Commercial	$269.45
Rate for Payer: Humana Medicare	$158.50
Rate for Payer: Kaiser Permanente Commercial	$285.30
Rate for Payer: Kaiser Permanente Medicaid	$161.67
Rate for Payer: Kaiser Permanente Medicare	$158.50
Rate for Payer: MDX Hawaii PPO	$307.49
Rate for Payer: Ohana Health Plan Medicaid	$158.50
Rate for Payer: Ohana Health Plan Medicare	$158.50
Rate for Payer: UnitedHealthcare Medicaid	$25.38
Rate for Payer: UnitedHealthcare Medicare	$158.50
Rate for Payer: University Health Alliance Commercial	$47.47

Bill Only 86022 Serotonin Release Assay, LMWH

Facility

$317.00

Service Code	HCPCS 86022
Hospital Charge Code	13395391
Hospital Revenue Code	300
Min. Negotiated Rate	$269.45
Max. Negotiated Rate	$307.49
Rate for Payer: Cash Price	$206.05
Rate for Payer: Health Management Network Commercial	$269.45
Rate for Payer: Kaiser Permanente Commercial	$285.30
Rate for Payer: MDX Hawaii PPO	$307.49

Bill Only 86036 ANCA Vasculitides

Facility

$301.00

Service Code	HCPCS 86036
Hospital Charge Code	13395377
Hospital Revenue Code	300
Min. Negotiated Rate	$255.85
Max. Negotiated Rate	$291.97
Rate for Payer: Cash Price	$195.65
Rate for Payer: Health Management Network Commercial	$255.85
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: MDX Hawaii PPO	$291.97

Bill Only 86036 ANCA Vasculitides

Facility

$301.00

Service Code	HCPCS 86036
Hospital Charge Code	13395377
Hospital Revenue Code	300
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$291.97
Rate for Payer: AlohaCare Medicaid	$150.50
Rate for Payer: AlohaCare Medicare	$150.50
Rate for Payer: Cash Price	$195.65
Rate for Payer: Cash Price	$195.65
Rate for Payer: Devoted Health Medicare	$165.55
Rate for Payer: Hawaii Medical Service Association ABD	$16.66
Rate for Payer: Hawaii Medical Service Association Commercial	$15.06
Rate for Payer: Hawaii Medical Service Association Medicare	$150.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.49
Rate for Payer: Hawaii Western Management Group Commercial	$12.05
Rate for Payer: Health Management Network Commercial	$255.85
Rate for Payer: Humana Medicare	$150.50
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: Kaiser Permanente Medicaid	$153.51
Rate for Payer: Kaiser Permanente Medicare	$150.50
Rate for Payer: MDX Hawaii PPO	$291.97
Rate for Payer: Ohana Health Plan Medicaid	$150.50
Rate for Payer: Ohana Health Plan Medicare	$150.50
Rate for Payer: UnitedHealthcare Medicaid	$7.23
Rate for Payer: UnitedHealthcare Medicare	$150.50
Rate for Payer: University Health Alliance Commercial	$219.40

Bill Only 86037 C-ANCA Titer

Facility

$130.00

Service Code	HCPCS 86037
Hospital Charge Code	13395379
Hospital Revenue Code	300
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$126.10
Rate for Payer: AlohaCare Medicaid	$65.00
Rate for Payer: AlohaCare Medicare	$65.00
Rate for Payer: Cash Price	$84.50
Rate for Payer: Cash Price	$84.50
Rate for Payer: Devoted Health Medicare	$71.50
Rate for Payer: Hawaii Medical Service Association ABD	$16.66
Rate for Payer: Hawaii Medical Service Association Commercial	$15.06
Rate for Payer: Hawaii Medical Service Association Medicare	$65.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.49
Rate for Payer: Hawaii Western Management Group Commercial	$12.05
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Humana Medicare	$65.00
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: Kaiser Permanente Medicaid	$66.30
Rate for Payer: Kaiser Permanente Medicare	$65.00
Rate for Payer: MDX Hawaii PPO	$126.10
Rate for Payer: Ohana Health Plan Medicaid	$65.00
Rate for Payer: Ohana Health Plan Medicare	$65.00
Rate for Payer: UnitedHealthcare Medicaid	$7.23
Rate for Payer: UnitedHealthcare Medicare	$65.00
Rate for Payer: University Health Alliance Commercial	$94.76

Bill Only 86037 C-ANCA Titer

Facility

$130.00

Service Code	HCPCS 86037
Hospital Charge Code	13395379
Hospital Revenue Code	300
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

Bill Only 86316 Chromogranin A

Facility

$157.00

Service Code	HCPCS 86316
Hospital Charge Code	13416117
Hospital Revenue Code	300
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$152.29
Rate for Payer: AlohaCare Medicaid	$78.50
Rate for Payer: AlohaCare Medicare	$78.50
Rate for Payer: Cash Price	$102.05
Rate for Payer: Cash Price	$102.05
Rate for Payer: Devoted Health Medicare	$86.35
Rate for Payer: Hawaii Medical Service Association ABD	$28.76
Rate for Payer: Hawaii Medical Service Association Commercial	$26.01
Rate for Payer: Hawaii Medical Service Association Medicare	$78.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.20
Rate for Payer: Hawaii Western Management Group Commercial	$20.81
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: Humana Medicare	$78.50
Rate for Payer: Kaiser Permanente Commercial	$141.30
Rate for Payer: Kaiser Permanente Medicaid	$80.07
Rate for Payer: Kaiser Permanente Medicare	$78.50
Rate for Payer: MDX Hawaii PPO	$152.29
Rate for Payer: Ohana Health Plan Medicaid	$78.50
Rate for Payer: Ohana Health Plan Medicare	$78.50
Rate for Payer: UnitedHealthcare Medicaid	$28.76
Rate for Payer: UnitedHealthcare Medicare	$78.50
Rate for Payer: University Health Alliance Commercial	$53.78

Bill Only 86316 Chromogranin A

Facility

$157.00

Service Code	HCPCS 86316
Hospital Charge Code	13416117
Hospital Revenue Code	300
Min. Negotiated Rate	$133.45
Max. Negotiated Rate	$152.29
Rate for Payer: Cash Price	$102.05
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: Kaiser Permanente Commercial	$141.30
Rate for Payer: MDX Hawaii PPO	$152.29

Bill Only 86359 CD4 T-Cell Count

Facility

$144.00

Service Code	HCPCS 86359
Hospital Charge Code	13395380
Hospital Revenue Code	300
Min. Negotiated Rate	$37.73
Max. Negotiated Rate	$139.68
Rate for Payer: AlohaCare Medicaid	$72.00
Rate for Payer: AlohaCare Medicare	$72.00
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Devoted Health Medicare	$79.20
Rate for Payer: Hawaii Medical Service Association ABD	$52.13
Rate for Payer: Hawaii Medical Service Association Commercial	$47.16
Rate for Payer: Hawaii Medical Service Association Medicare	$72.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$54.74
Rate for Payer: Hawaii Western Management Group Commercial	$37.73
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Humana Medicare	$72.00
Rate for Payer: Kaiser Permanente Commercial	$129.60
Rate for Payer: Kaiser Permanente Medicaid	$73.44
Rate for Payer: Kaiser Permanente Medicare	$72.00
Rate for Payer: MDX Hawaii PPO	$139.68
Rate for Payer: Ohana Health Plan Medicaid	$72.00
Rate for Payer: Ohana Health Plan Medicare	$72.00
Rate for Payer: UnitedHealthcare Medicaid	$52.13
Rate for Payer: UnitedHealthcare Medicare	$72.00
Rate for Payer: University Health Alliance Commercial	$97.50

Bill Only 86359 CD4 T-Cell Count

Facility

$144.00

Service Code	HCPCS 86359
Hospital Charge Code	13395380
Hospital Revenue Code	300
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$139.68
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Kaiser Permanente Commercial	$129.60
Rate for Payer: MDX Hawaii PPO	$139.68

Bill Only 86381 Mitochondrial M2 Antibody

Facility

$108.00

Service Code	HCPCS 86381
Hospital Charge Code	13395389
Hospital Revenue Code	300
Min. Negotiated Rate	$15.27
Max. Negotiated Rate	$104.76
Rate for Payer: AlohaCare Medicaid	$54.00
Rate for Payer: AlohaCare Medicare	$54.00
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cash Price	$70.20
Rate for Payer: Devoted Health Medicare	$59.40
Rate for Payer: Hawaii Medical Service Association ABD	$35.54
Rate for Payer: Hawaii Medical Service Association Commercial	$31.81
Rate for Payer: Hawaii Medical Service Association Medicare	$54.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37.32
Rate for Payer: Hawaii Western Management Group Commercial	$25.45
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Humana Medicare	$54.00
Rate for Payer: Kaiser Permanente Commercial	$97.20
Rate for Payer: Kaiser Permanente Medicaid	$55.08
Rate for Payer: Kaiser Permanente Medicare	$54.00
Rate for Payer: MDX Hawaii PPO	$104.76
Rate for Payer: Ohana Health Plan Medicaid	$54.00
Rate for Payer: Ohana Health Plan Medicare	$54.00
Rate for Payer: UnitedHealthcare Medicaid	$15.27
Rate for Payer: UnitedHealthcare Medicare	$54.00
Rate for Payer: University Health Alliance Commercial	$78.72

Bill Only 86381 Mitochondrial M2 Antibody

Facility

$108.00

Service Code	HCPCS 86381
Hospital Charge Code	13395389
Hospital Revenue Code	300
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$70.20
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Kaiser Permanente Commercial	$97.20
Rate for Payer: MDX Hawaii PPO	$104.76

Bill Only 86593 RPR Titer

Facility

$20.00

Service Code	HCPCS 86593
Hospital Charge Code	13416125
Hospital Revenue Code	300
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$19.40
Rate for Payer: AlohaCare Medicaid	$10.00
Rate for Payer: AlohaCare Medicare	$10.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Devoted Health Medicare	$11.00
Rate for Payer: Hawaii Medical Service Association ABD	$6.09
Rate for Payer: Hawaii Medical Service Association Commercial	$5.50
Rate for Payer: Hawaii Medical Service Association Medicare	$10.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.39
Rate for Payer: Hawaii Western Management Group Commercial	$4.40
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Humana Medicare	$10.00
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: Kaiser Permanente Medicare	$10.00
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: Ohana Health Plan Medicaid	$10.00
Rate for Payer: Ohana Health Plan Medicare	$10.00
Rate for Payer: UnitedHealthcare Medicaid	$6.09
Rate for Payer: UnitedHealthcare Medicare	$10.00
Rate for Payer: University Health Alliance Commercial	$11.40

Bill Only 86593 RPR Titer

Facility

$20.00

Service Code	HCPCS 86593
Hospital Charge Code	13416125
Hospital Revenue Code	300
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$13.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: MDX Hawaii PPO	$19.40

Know your out-of-pocket cost for care.

All Charges