Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Bill Only 86870 Antibody Identification

Facility

$91.00

Service Code	HCPCS 86870
Hospital Charge Code	13407397
Hospital Revenue Code	300
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$457.76
Rate for Payer: AlohaCare Medicaid	$45.50
Rate for Payer: AlohaCare Medicare	$45.50
Rate for Payer: Cash Price	$59.15
Rate for Payer: Cash Price	$59.15
Rate for Payer: Devoted Health Medicare	$50.05
Rate for Payer: Hawaii Medical Service Association ABD	$55.70
Rate for Payer: Hawaii Medical Service Association Commercial	$457.76
Rate for Payer: Hawaii Medical Service Association Medicare	$45.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.00
Rate for Payer: Hawaii Western Management Group Commercial	$366.21
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Humana Medicare	$45.50
Rate for Payer: Kaiser Permanente Commercial	$81.90
Rate for Payer: Kaiser Permanente Medicaid	$46.41
Rate for Payer: Kaiser Permanente Medicare	$45.50
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: Ohana Health Plan Medicaid	$45.50
Rate for Payer: Ohana Health Plan Medicare	$45.50
Rate for Payer: UnitedHealthcare Medicaid	$55.70
Rate for Payer: UnitedHealthcare Medicare	$45.50
Rate for Payer: University Health Alliance Commercial	$66.33

Bill Only 86870 Antibody Identification

Facility

$91.00

Service Code	HCPCS 86870
Hospital Charge Code	13407397
Hospital Revenue Code	300
Min. Negotiated Rate	$77.35
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$59.15
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Kaiser Permanente Commercial	$81.90
Rate for Payer: MDX Hawaii PPO	$88.27

Bill Only 87045 Stool Culture

Facility

$125.00

Service Code	HCPCS 87045
Hospital Charge Code	13395392
Hospital Revenue Code	300
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$121.25
Rate for Payer: Humana Medicare	$62.50
Rate for Payer: AlohaCare Medicaid	$62.50
Rate for Payer: AlohaCare Medicare	$62.50
Rate for Payer: Cash Price	$81.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Devoted Health Medicare	$68.75
Rate for Payer: Hawaii Medical Service Association ABD	$13.04
Rate for Payer: Hawaii Medical Service Association Commercial	$11.80
Rate for Payer: Hawaii Medical Service Association Medicare	$62.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.69
Rate for Payer: Hawaii Western Management Group Commercial	$9.44
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: Kaiser Permanente Medicare	$62.50
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: Ohana Health Plan Medicaid	$62.50
Rate for Payer: Ohana Health Plan Medicare	$62.50
Rate for Payer: UnitedHealthcare Medicaid	$13.04
Rate for Payer: UnitedHealthcare Medicare	$62.50
Rate for Payer: University Health Alliance Commercial	$24.38

Bill Only 87045 Stool Culture

Facility

$125.00

Service Code	HCPCS 87045
Hospital Charge Code	13395392
Hospital Revenue Code	300
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: MDX Hawaii PPO	$121.25

Bill Only 87045 Stool Culture, Campy Antigen, and Shiga Toxin

Facility

$238.00

Service Code	HCPCS 87045
Hospital Charge Code	13407411
Hospital Revenue Code	300
Min. Negotiated Rate	$202.30
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$154.70
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Kaiser Permanente Commercial	$214.20
Rate for Payer: MDX Hawaii PPO	$230.86

Bill Only 87045 Stool Culture, Campy Antigen, and Shiga Toxin

Facility

$238.00

Service Code	HCPCS 87045
Hospital Charge Code	13407411
Hospital Revenue Code	300
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$230.86
Rate for Payer: AlohaCare Medicaid	$119.00
Rate for Payer: AlohaCare Medicare	$119.00
Rate for Payer: Cash Price	$154.70
Rate for Payer: Cash Price	$154.70
Rate for Payer: Devoted Health Medicare	$130.90
Rate for Payer: Hawaii Medical Service Association ABD	$13.04
Rate for Payer: Hawaii Medical Service Association Commercial	$11.80
Rate for Payer: Hawaii Medical Service Association Medicare	$119.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.69
Rate for Payer: Hawaii Western Management Group Commercial	$9.44
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Humana Medicare	$119.00
Rate for Payer: Kaiser Permanente Commercial	$214.20
Rate for Payer: Kaiser Permanente Medicaid	$121.38
Rate for Payer: Kaiser Permanente Medicare	$119.00
Rate for Payer: MDX Hawaii PPO	$230.86
Rate for Payer: Ohana Health Plan Medicaid	$119.00
Rate for Payer: Ohana Health Plan Medicare	$119.00
Rate for Payer: UnitedHealthcare Medicaid	$13.04
Rate for Payer: UnitedHealthcare Medicare	$119.00
Rate for Payer: University Health Alliance Commercial	$24.38

Bill Only 87077 Ident, Aerobic Isol, 5

Facility

$104.00

Service Code	HCPCS 87077
Hospital Charge Code	13407404
Hospital Revenue Code	300
Min. Negotiated Rate	$88.40
Max. Negotiated Rate	$100.88
Rate for Payer: Cash Price	$67.60
Rate for Payer: Health Management Network Commercial	$88.40
Rate for Payer: Kaiser Permanente Commercial	$93.60
Rate for Payer: MDX Hawaii PPO	$100.88

Bill Only 87077 Ident, Aerobic Isol, 5

Facility

$104.00

Service Code	HCPCS 87077
Hospital Charge Code	13407404
Hospital Revenue Code	300
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$100.88
Rate for Payer: Kaiser Permanente Medicaid	$53.04
Rate for Payer: AlohaCare Medicaid	$52.00
Rate for Payer: AlohaCare Medicare	$52.00
Rate for Payer: Cash Price	$67.60
Rate for Payer: Cash Price	$67.60
Rate for Payer: Devoted Health Medicare	$57.20
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.10
Rate for Payer: Hawaii Medical Service Association Medicare	$52.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.72
Rate for Payer: Hawaii Western Management Group Commercial	$8.08
Rate for Payer: Health Management Network Commercial	$88.40
Rate for Payer: Humana Medicare	$52.00
Rate for Payer: Kaiser Permanente Commercial	$93.60
Rate for Payer: Kaiser Permanente Medicare	$52.00
Rate for Payer: MDX Hawaii PPO	$100.88
Rate for Payer: Ohana Health Plan Medicaid	$52.00
Rate for Payer: Ohana Health Plan Medicare	$52.00
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$52.00
Rate for Payer: University Health Alliance Commercial	$20.89

Bill Only 87107 Ident, Mold Isolates, 1

Facility

$23.00

Service Code	HCPCS 87107
Hospital Charge Code	13416122
Hospital Revenue Code	300
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$14.95
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

Bill Only 87107 Ident, Mold Isolates, 1

Facility

$23.00

Service Code	HCPCS 87107
Hospital Charge Code	13416122
Hospital Revenue Code	300
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$26.68
Rate for Payer: AlohaCare Medicaid	$11.50
Rate for Payer: AlohaCare Medicare	$11.50
Rate for Payer: Cash Price	$14.95
Rate for Payer: Cash Price	$14.95
Rate for Payer: Devoted Health Medicare	$12.65
Rate for Payer: Hawaii Medical Service Association ABD	$14.42
Rate for Payer: Hawaii Medical Service Association Commercial	$12.90
Rate for Payer: Hawaii Medical Service Association Medicare	$11.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.14
Rate for Payer: Hawaii Western Management Group Commercial	$10.32
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Humana Medicare	$11.50
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: Kaiser Permanente Medicare	$11.50
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: Ohana Health Plan Medicaid	$11.50
Rate for Payer: Ohana Health Plan Medicare	$11.50
Rate for Payer: UnitedHealthcare Medicaid	$14.42
Rate for Payer: UnitedHealthcare Medicare	$11.50
Rate for Payer: University Health Alliance Commercial	$26.68

Bill Only 87181 Disk Diffusion and 2 E-test

Facility

$71.00

Service Code	HCPCS 87181
Hospital Charge Code	13416119
Hospital Revenue Code	300
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicare	$35.50
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Devoted Health Medicare	$39.05
Rate for Payer: Hawaii Medical Service Association ABD	$2.57
Rate for Payer: Hawaii Medical Service Association Commercial	$5.94
Rate for Payer: Hawaii Medical Service Association Medicare	$35.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.70
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$35.50
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$35.50
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$35.50
Rate for Payer: Ohana Health Plan Medicare	$35.50
Rate for Payer: UnitedHealthcare Medicaid	$2.57
Rate for Payer: UnitedHealthcare Medicare	$35.50
Rate for Payer: University Health Alliance Commercial	$4.81

Bill Only 87181 Disk Diffusion and 2 E-test

Facility

$71.00

Service Code	HCPCS 87181
Hospital Charge Code	13416119
Hospital Revenue Code	300
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

Bill Only 87181 Disk Diffusion and E-test

Facility

$71.00

Service Code	HCPCS 87181
Hospital Charge Code	13416120
Hospital Revenue Code	300
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

Bill Only 87181 Disk Diffusion and E-test

Facility

$71.00

Service Code	HCPCS 87181
Hospital Charge Code	13416120
Hospital Revenue Code	300
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicare	$35.50
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Devoted Health Medicare	$39.05
Rate for Payer: Hawaii Medical Service Association ABD	$2.57
Rate for Payer: Hawaii Medical Service Association Commercial	$5.94
Rate for Payer: Hawaii Medical Service Association Medicare	$35.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.70
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$35.50
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$35.50
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$35.50
Rate for Payer: Ohana Health Plan Medicare	$35.50
Rate for Payer: UnitedHealthcare Medicaid	$2.57
Rate for Payer: UnitedHealthcare Medicare	$35.50
Rate for Payer: University Health Alliance Commercial	$4.81

Bill Only 87186 Susceptibility,Aerobic Bacteria,MIC

Facility

$152.00

Service Code	HCPCS 87186
Hospital Charge Code	13407416
Hospital Revenue Code	300
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$98.80
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: MDX Hawaii PPO	$147.44

Bill Only 87186 Susceptibility,Aerobic Bacteria,MIC

Facility

$152.00

Service Code	HCPCS 87186
Hospital Charge Code	13407416
Hospital Revenue Code	300
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$147.44
Rate for Payer: AlohaCare Medicaid	$76.00
Rate for Payer: AlohaCare Medicare	$76.00
Rate for Payer: Cash Price	$98.80
Rate for Payer: Cash Price	$98.80
Rate for Payer: Devoted Health Medicare	$83.60
Rate for Payer: Hawaii Medical Service Association ABD	$11.94
Rate for Payer: Hawaii Medical Service Association Commercial	$10.81
Rate for Payer: Hawaii Medical Service Association Medicare	$76.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.54
Rate for Payer: Hawaii Western Management Group Commercial	$8.65
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Humana Medicare	$76.00
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: Kaiser Permanente Medicaid	$77.52
Rate for Payer: Kaiser Permanente Medicare	$76.00
Rate for Payer: MDX Hawaii PPO	$147.44
Rate for Payer: Ohana Health Plan Medicaid	$76.00
Rate for Payer: Ohana Health Plan Medicare	$76.00
Rate for Payer: UnitedHealthcare Medicaid	$11.94
Rate for Payer: UnitedHealthcare Medicare	$76.00
Rate for Payer: University Health Alliance Commercial	$22.35

Bill Only 87206 Fungus Smear by Calcofluor White

Facility

$16.00

Service Code	HCPCS 87206
Hospital Charge Code	13395383
Hospital Revenue Code	300
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$15.52
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$8.00
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cash Price	$10.40
Rate for Payer: Devoted Health Medicare	$8.80
Rate for Payer: Hawaii Medical Service Association ABD	$7.42
Rate for Payer: Hawaii Medical Service Association Commercial	$6.74
Rate for Payer: Hawaii Medical Service Association Medicare	$8.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.79
Rate for Payer: Hawaii Western Management Group Commercial	$5.39
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Humana Medicare	$8.00
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$8.00
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$8.00
Rate for Payer: Ohana Health Plan Medicare	$8.00
Rate for Payer: UnitedHealthcare Medicaid	$7.42
Rate for Payer: UnitedHealthcare Medicare	$8.00
Rate for Payer: University Health Alliance Commercial	$13.88

Bill Only 87206 Fungus Smear by Calcofluor White

Facility

$16.00

Service Code	HCPCS 87206
Hospital Charge Code	13395383
Hospital Revenue Code	300
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$10.40
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

Bill Only 87305 Aspergillus Ag

Facility

$232.00

Service Code	HCPCS 87305
Hospital Charge Code	13407398
Hospital Revenue Code	300
Min. Negotiated Rate	$197.20
Max. Negotiated Rate	$225.04
Rate for Payer: Cash Price	$150.80
Rate for Payer: Health Management Network Commercial	$197.20
Rate for Payer: Kaiser Permanente Commercial	$208.80
Rate for Payer: MDX Hawaii PPO	$225.04

Bill Only 87305 Aspergillus Ag

Facility

$232.00

Service Code	HCPCS 87305
Hospital Charge Code	13407398
Hospital Revenue Code	300
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$225.04
Rate for Payer: AlohaCare Medicaid	$116.00
Rate for Payer: AlohaCare Medicare	$116.00
Rate for Payer: Cash Price	$150.80
Rate for Payer: Cash Price	$150.80
Rate for Payer: Devoted Health Medicare	$127.60
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$116.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$197.20
Rate for Payer: Humana Medicare	$116.00
Rate for Payer: Kaiser Permanente Commercial	$208.80
Rate for Payer: Kaiser Permanente Medicaid	$118.32
Rate for Payer: Kaiser Permanente Medicare	$116.00
Rate for Payer: MDX Hawaii PPO	$225.04
Rate for Payer: Ohana Health Plan Medicaid	$116.00
Rate for Payer: Ohana Health Plan Medicare	$116.00
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$116.00
Rate for Payer: University Health Alliance Commercial	$31.01

Bill Only 87449 Campylobacter Antigen

Facility

$70.00

Service Code	HCPCS 87449
Hospital Charge Code	13407401
Hospital Revenue Code	300
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$67.90
Rate for Payer: AlohaCare Medicaid	$35.00
Rate for Payer: AlohaCare Medicare	$35.00
Rate for Payer: Cash Price	$45.50
Rate for Payer: Cash Price	$45.50
Rate for Payer: Devoted Health Medicare	$38.50
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$35.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Humana Medicare	$35.00
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: Kaiser Permanente Medicaid	$35.70
Rate for Payer: Kaiser Permanente Medicare	$35.00
Rate for Payer: MDX Hawaii PPO	$67.90
Rate for Payer: Ohana Health Plan Medicaid	$35.00
Rate for Payer: Ohana Health Plan Medicare	$35.00
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$35.00
Rate for Payer: University Health Alliance Commercial	$31.01

Bill Only 87449 Campylobacter Antigen

Facility

$70.00

Service Code	HCPCS 87449
Hospital Charge Code	13407401
Hospital Revenue Code	300
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$45.50
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: MDX Hawaii PPO	$67.90

Bill Only 87449 Fungitell, Serum

Facility

$154.00

Service Code	HCPCS 87449
Hospital Charge Code	13395382
Hospital Revenue Code	300
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

Bill Only 87449 Fungitell, Serum

Facility

$154.00

Service Code	HCPCS 87449
Hospital Charge Code	13395382
Hospital Revenue Code	300
Min. Negotiated Rate	$11.98
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	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$14.97
Rate for Payer: Hawaii Medical Service Association Medicare	$77.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$11.98
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	$16.58
Rate for Payer: UnitedHealthcare Medicare	$77.00
Rate for Payer: University Health Alliance Commercial	$31.01

Bill Only 87502 Influenza A/B (Cepheid)

Facility

$305.00

Service Code	HCPCS 87502
Hospital Charge Code	13407405
Hospital Revenue Code	300
Min. Negotiated Rate	$259.25
Max. Negotiated Rate	$295.85
Rate for Payer: Cash Price	$198.25
Rate for Payer: Health Management Network Commercial	$259.25
Rate for Payer: Kaiser Permanente Commercial	$274.50
Rate for Payer: MDX Hawaii PPO	$295.85

Know your out-of-pocket cost for care.

All Charges