Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

CT Angiography Chest w/ Contrast

Facility

$1,302.00

Service Code	HCPCS 71275
Hospital Charge Code	424712750
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$1,262.94
Rate for Payer: AlohaCare Medicaid	$651.00
Rate for Payer: AlohaCare Medicare	$546.84
Rate for Payer: Cash Price	$846.30
Rate for Payer: Cash Price	$846.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,197.84
Rate for Payer: Devoted Health Medicare	$546.84
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$320.86
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$546.84
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Humana Medicare	$546.84
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: Kaiser Permanente Medicaid	$664.02
Rate for Payer: Kaiser Permanente Medicare	$546.84
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: Ohana Health Plan Medicaid	$546.84
Rate for Payer: Ohana Health Plan Medicare	$546.84
Rate for Payer: UnitedHealthcare Medicaid	$320.86
Rate for Payer: UnitedHealthcare Medicare	$546.84
Rate for Payer: University Health Alliance Commercial	$860.75

CT Angiography Chest w/ Contrast

Facility

$1,302.00

Service Code	HCPCS 71275
Hospital Charge Code	424712750
Hospital Revenue Code	352
Min. Negotiated Rate	$1,106.70
Max. Negotiated Rate	$1,262.94
Rate for Payer: Cash Price	$846.30
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: MDX Hawaii PPO	$1,262.94

CT Angiography Head/Neck w/ Contrast

Facility

$1,302.00

Service Code	HCPCS 70496
Hospital Charge Code	424704961
Hospital Revenue Code	351
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$1,262.94
Rate for Payer: AlohaCare Medicaid	$651.00
Rate for Payer: AlohaCare Medicare	$546.84
Rate for Payer: Cash Price	$846.30
Rate for Payer: Cash Price	$846.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,197.84
Rate for Payer: Devoted Health Medicare	$546.84
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$279.09
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$546.84
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Humana Medicare	$546.84
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: Kaiser Permanente Medicaid	$664.02
Rate for Payer: Kaiser Permanente Medicare	$546.84
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: Ohana Health Plan Medicaid	$546.84
Rate for Payer: Ohana Health Plan Medicare	$546.84
Rate for Payer: UnitedHealthcare Medicaid	$279.09
Rate for Payer: UnitedHealthcare Medicare	$546.84
Rate for Payer: University Health Alliance Commercial	$842.03

CT Angiography Head/Neck w/ Contrast

Facility

$1,302.00

Service Code	HCPCS 70496
Hospital Charge Code	424704961
Hospital Revenue Code	351
Min. Negotiated Rate	$1,106.70
Max. Negotiated Rate	$1,262.94
Rate for Payer: Cash Price	$846.30
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: MDX Hawaii PPO	$1,262.94

CT Angiography Head w/ Contrast

Facility

$1,302.00

Service Code	HCPCS 70496
Hospital Charge Code	424704960
Hospital Revenue Code	351
Min. Negotiated Rate	$1,106.70
Max. Negotiated Rate	$1,262.94
Rate for Payer: Cash Price	$846.30
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: MDX Hawaii PPO	$1,262.94

CT Angiography Head w/ Contrast

Facility

$1,302.00

Service Code	HCPCS 70496
Hospital Charge Code	424704960
Hospital Revenue Code	351
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$1,262.94
Rate for Payer: AlohaCare Medicaid	$651.00
Rate for Payer: AlohaCare Medicare	$546.84
Rate for Payer: Cash Price	$846.30
Rate for Payer: Cash Price	$846.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,197.84
Rate for Payer: Devoted Health Medicare	$546.84
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$279.09
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$546.84
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Humana Medicare	$546.84
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: Kaiser Permanente Medicaid	$664.02
Rate for Payer: Kaiser Permanente Medicare	$546.84
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: Ohana Health Plan Medicaid	$546.84
Rate for Payer: Ohana Health Plan Medicare	$546.84
Rate for Payer: UnitedHealthcare Medicaid	$279.09
Rate for Payer: UnitedHealthcare Medicare	$546.84
Rate for Payer: University Health Alliance Commercial	$842.03

CT Angiography Neck w/ Contrast

Facility

$912.00

Service Code	HCPCS 71275
Hospital Charge Code	424704980
Hospital Revenue Code	351
Min. Negotiated Rate	$775.20
Max. Negotiated Rate	$884.64
Rate for Payer: Cash Price	$592.80
Rate for Payer: Health Management Network Commercial	$775.20
Rate for Payer: Kaiser Permanente Commercial	$820.80
Rate for Payer: MDX Hawaii PPO	$884.64

CT Angiography Neck w/ Contrast

Facility

$912.00

Service Code	HCPCS 71275
Hospital Charge Code	424704980
Hospital Revenue Code	351
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$884.64
Rate for Payer: AlohaCare Medicaid	$456.00
Rate for Payer: AlohaCare Medicare	$383.04
Rate for Payer: Cash Price	$592.80
Rate for Payer: Cash Price	$592.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$839.04
Rate for Payer: Devoted Health Medicare	$383.04
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$320.86
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$383.04
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$775.20
Rate for Payer: Humana Medicare	$383.04
Rate for Payer: Kaiser Permanente Commercial	$820.80
Rate for Payer: Kaiser Permanente Medicaid	$465.12
Rate for Payer: Kaiser Permanente Medicare	$383.04
Rate for Payer: MDX Hawaii PPO	$884.64
Rate for Payer: Ohana Health Plan Medicaid	$383.04
Rate for Payer: Ohana Health Plan Medicare	$383.04
Rate for Payer: UnitedHealthcare Medicaid	$320.86
Rate for Payer: UnitedHealthcare Medicare	$383.04
Rate for Payer: University Health Alliance Commercial	$860.75

CTA PELVIS W/WO CON

Facility

$1,302.00

Service Code	HCPCS 72191
Hospital Charge Code	424721910
Hospital Revenue Code	352
Min. Negotiated Rate	$1,106.70
Max. Negotiated Rate	$1,262.94
Rate for Payer: Cash Price	$846.30
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: MDX Hawaii PPO	$1,262.94

CTA PELVIS W/WO CON

Facility

$1,302.00

Service Code	HCPCS 72191
Hospital Charge Code	424721910
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$1,262.94
Rate for Payer: AlohaCare Medicaid	$651.00
Rate for Payer: AlohaCare Medicare	$546.84
Rate for Payer: Cash Price	$846.30
Rate for Payer: Cash Price	$846.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,197.84
Rate for Payer: Devoted Health Medicare	$546.84
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$311.76
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$546.84
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Humana Medicare	$546.84
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: Kaiser Permanente Medicaid	$664.02
Rate for Payer: Kaiser Permanente Medicare	$546.84
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: Ohana Health Plan Medicaid	$546.84
Rate for Payer: Ohana Health Plan Medicare	$546.84
Rate for Payer: UnitedHealthcare Medicaid	$311.76
Rate for Payer: UnitedHealthcare Medicare	$546.84
Rate for Payer: University Health Alliance Commercial	$850.50

CT CERVICAL SPINE WO CON

Facility

$1,218.00

Service Code	HCPCS 72125
Hospital Charge Code	424721250
Hospital Revenue Code	352
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$1,181.46
Rate for Payer: AlohaCare Medicaid	$609.00
Rate for Payer: AlohaCare Medicare	$511.56
Rate for Payer: Cash Price	$791.70
Rate for Payer: Cash Price	$791.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,120.56
Rate for Payer: Devoted Health Medicare	$511.56
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$194.84
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$511.56
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$1,035.30
Rate for Payer: Humana Medicare	$511.56
Rate for Payer: Kaiser Permanente Commercial	$1,096.20
Rate for Payer: Kaiser Permanente Medicaid	$621.18
Rate for Payer: Kaiser Permanente Medicare	$511.56
Rate for Payer: MDX Hawaii PPO	$1,181.46
Rate for Payer: Ohana Health Plan Medicaid	$511.56
Rate for Payer: Ohana Health Plan Medicare	$511.56
Rate for Payer: UnitedHealthcare Medicaid	$194.84
Rate for Payer: UnitedHealthcare Medicare	$511.56
Rate for Payer: University Health Alliance Commercial	$502.27

CT CERVICAL SPINE WO CON

Facility

$1,218.00

Service Code	HCPCS 72125
Hospital Charge Code	424721250
Hospital Revenue Code	352
Min. Negotiated Rate	$1,035.30
Max. Negotiated Rate	$1,181.46
Rate for Payer: Cash Price	$791.70
Rate for Payer: Health Management Network Commercial	$1,035.30
Rate for Payer: Kaiser Permanente Commercial	$1,096.20
Rate for Payer: MDX Hawaii PPO	$1,181.46

CT CERV SPINE W CON

Facility

$2,686.00

Service Code	HCPCS 72126
Hospital Charge Code	424721260
Hospital Revenue Code	352
Min. Negotiated Rate	$2,283.10
Max. Negotiated Rate	$2,605.42
Rate for Payer: Cash Price	$1,745.90
Rate for Payer: Health Management Network Commercial	$2,283.10
Rate for Payer: Kaiser Permanente Commercial	$2,417.40
Rate for Payer: MDX Hawaii PPO	$2,605.42

CT CERV SPINE W CON

Facility

$2,686.00

Service Code	HCPCS 72126
Hospital Charge Code	424721260
Hospital Revenue Code	352
Min. Negotiated Rate	$232.90
Max. Negotiated Rate	$2,605.42
Rate for Payer: AlohaCare Medicaid	$1,343.00
Rate for Payer: AlohaCare Medicare	$1,128.12
Rate for Payer: Cash Price	$1,745.90
Rate for Payer: Cash Price	$1,745.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2,471.12
Rate for Payer: Devoted Health Medicare	$1,128.12
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$232.90
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$1,128.12
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$2,283.10
Rate for Payer: Humana Medicare	$1,128.12
Rate for Payer: Kaiser Permanente Commercial	$2,417.40
Rate for Payer: Kaiser Permanente Medicaid	$1,369.86
Rate for Payer: Kaiser Permanente Medicare	$1,128.12
Rate for Payer: MDX Hawaii PPO	$2,605.42
Rate for Payer: Ohana Health Plan Medicaid	$1,128.12
Rate for Payer: Ohana Health Plan Medicare	$1,128.12
Rate for Payer: UnitedHealthcare Medicaid	$232.90
Rate for Payer: UnitedHealthcare Medicare	$1,128.12
Rate for Payer: University Health Alliance Commercial	$683.96

CT CERV SPINE WO W CON

Facility

$1,966.00

Service Code	HCPCS 72127
Hospital Charge Code	424721270
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$1,907.02
Rate for Payer: AlohaCare Medicaid	$983.00
Rate for Payer: AlohaCare Medicare	$825.72
Rate for Payer: Cash Price	$1,277.90
Rate for Payer: Cash Price	$1,277.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,808.72
Rate for Payer: Devoted Health Medicare	$825.72
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$291.10
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$825.72
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$1,671.10
Rate for Payer: Humana Medicare	$825.72
Rate for Payer: Kaiser Permanente Commercial	$1,769.40
Rate for Payer: Kaiser Permanente Medicaid	$1,002.66
Rate for Payer: Kaiser Permanente Medicare	$825.72
Rate for Payer: MDX Hawaii PPO	$1,907.02
Rate for Payer: Ohana Health Plan Medicaid	$825.72
Rate for Payer: Ohana Health Plan Medicare	$825.72
Rate for Payer: UnitedHealthcare Medicaid	$291.10
Rate for Payer: UnitedHealthcare Medicare	$825.72
Rate for Payer: University Health Alliance Commercial	$789.62

CT CERV SPINE WO W CON

Facility

$1,966.00

Service Code	HCPCS 72127
Hospital Charge Code	424721270
Hospital Revenue Code	352
Min. Negotiated Rate	$1,671.10
Max. Negotiated Rate	$1,907.02
Rate for Payer: Cash Price	$1,277.90
Rate for Payer: Health Management Network Commercial	$1,671.10
Rate for Payer: Kaiser Permanente Commercial	$1,769.40
Rate for Payer: MDX Hawaii PPO	$1,907.02

CT Chest /Abdomen/Pelvis

Facility

$785.00

Service Code	HCPCS 71260
Hospital Charge Code	424712600
Hospital Revenue Code	352
Min. Negotiated Rate	$667.25
Max. Negotiated Rate	$761.45
Rate for Payer: Cash Price	$510.25
Rate for Payer: Health Management Network Commercial	$667.25
Rate for Payer: Kaiser Permanente Commercial	$706.50
Rate for Payer: MDX Hawaii PPO	$761.45

CT Chest /Abdomen/Pelvis

Facility

$785.00

Service Code	HCPCS 71260
Hospital Charge Code	424712600
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$761.45
Rate for Payer: AlohaCare Medicaid	$392.50
Rate for Payer: AlohaCare Medicare	$329.70
Rate for Payer: Cash Price	$510.25
Rate for Payer: Cash Price	$510.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$722.20
Rate for Payer: Devoted Health Medicare	$329.70
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$232.90
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$329.70
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$667.25
Rate for Payer: Humana Medicare	$329.70
Rate for Payer: Kaiser Permanente Commercial	$706.50
Rate for Payer: Kaiser Permanente Medicaid	$400.35
Rate for Payer: Kaiser Permanente Medicare	$329.70
Rate for Payer: MDX Hawaii PPO	$761.45
Rate for Payer: Ohana Health Plan Medicaid	$329.70
Rate for Payer: Ohana Health Plan Medicare	$329.70
Rate for Payer: UnitedHealthcare Medicaid	$232.90
Rate for Payer: UnitedHealthcare Medicare	$329.70
Rate for Payer: University Health Alliance Commercial	$686.18

CT Chest /Abdomen/Pelvis

Facility

$1,302.00

Service Code	HCPCS 71260
Hospital Charge Code	424712601
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$1,262.94
Rate for Payer: AlohaCare Medicaid	$651.00
Rate for Payer: AlohaCare Medicare	$546.84
Rate for Payer: Cash Price	$846.30
Rate for Payer: Cash Price	$846.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,197.84
Rate for Payer: Devoted Health Medicare	$546.84
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$232.90
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$546.84
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Humana Medicare	$546.84
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: Kaiser Permanente Medicaid	$664.02
Rate for Payer: Kaiser Permanente Medicare	$546.84
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: Ohana Health Plan Medicaid	$546.84
Rate for Payer: Ohana Health Plan Medicare	$546.84
Rate for Payer: UnitedHealthcare Medicaid	$232.90
Rate for Payer: UnitedHealthcare Medicare	$546.84
Rate for Payer: University Health Alliance Commercial	$686.18

CT Chest /Abdomen/Pelvis

Facility

$1,302.00

Service Code	HCPCS 71260
Hospital Charge Code	424712601
Hospital Revenue Code	352
Min. Negotiated Rate	$1,106.70
Max. Negotiated Rate	$1,262.94
Rate for Payer: Cash Price	$846.30
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: MDX Hawaii PPO	$1,262.94

CT Chest /Abdomen/Pelvis w/ Contrast

Facility

$955.00

Service Code	HCPCS 71260
Hospital Charge Code	424712601
Hospital Revenue Code	352
Min. Negotiated Rate	$811.75
Max. Negotiated Rate	$926.35
Rate for Payer: Cash Price	$620.75
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Kaiser Permanente Commercial	$859.50
Rate for Payer: MDX Hawaii PPO	$926.35

CT Chest /Abdomen/Pelvis w/ Contrast

Facility

$955.00

Service Code	HCPCS 71260
Hospital Charge Code	424712601
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$926.35
Rate for Payer: AlohaCare Medicaid	$477.50
Rate for Payer: AlohaCare Medicare	$401.10
Rate for Payer: Cash Price	$620.75
Rate for Payer: Cash Price	$620.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$878.60
Rate for Payer: Devoted Health Medicare	$401.10
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$232.90
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$401.10
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$811.75
Rate for Payer: Humana Medicare	$401.10
Rate for Payer: Kaiser Permanente Commercial	$859.50
Rate for Payer: Kaiser Permanente Medicaid	$487.05
Rate for Payer: Kaiser Permanente Medicare	$401.10
Rate for Payer: MDX Hawaii PPO	$926.35
Rate for Payer: Ohana Health Plan Medicaid	$401.10
Rate for Payer: Ohana Health Plan Medicare	$401.10
Rate for Payer: UnitedHealthcare Medicaid	$232.90
Rate for Payer: UnitedHealthcare Medicare	$401.10
Rate for Payer: University Health Alliance Commercial	$686.18

CT Chest /Abdomen/Pelvis w/o Contrast

Facility

$1,302.00

Service Code	HCPCS 71260
Hospital Charge Code	424712601
Hospital Revenue Code	352
Min. Negotiated Rate	$207.21
Max. Negotiated Rate	$1,262.94
Rate for Payer: AlohaCare Medicaid	$651.00
Rate for Payer: AlohaCare Medicare	$546.84
Rate for Payer: Cash Price	$846.30
Rate for Payer: Cash Price	$846.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,197.84
Rate for Payer: Devoted Health Medicare	$546.84
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$232.90
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$546.84
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Humana Medicare	$546.84
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: Kaiser Permanente Medicaid	$664.02
Rate for Payer: Kaiser Permanente Medicare	$546.84
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: Ohana Health Plan Medicaid	$546.84
Rate for Payer: Ohana Health Plan Medicare	$546.84
Rate for Payer: UnitedHealthcare Medicaid	$232.90
Rate for Payer: UnitedHealthcare Medicare	$546.84
Rate for Payer: University Health Alliance Commercial	$686.18

CT Chest /Abdomen/Pelvis w/o Contrast

Facility

$1,302.00

Service Code	HCPCS 71260
Hospital Charge Code	424712601
Hospital Revenue Code	352
Min. Negotiated Rate	$1,106.70
Max. Negotiated Rate	$1,262.94
Rate for Payer: Cash Price	$846.30
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: MDX Hawaii PPO	$1,262.94

CT HEAD BRAIN W CON

Facility

$1,642.00

Service Code	HCPCS 70460
Hospital Charge Code	424704600
Hospital Revenue Code	351
Min. Negotiated Rate	$186.48
Max. Negotiated Rate	$1,592.74
Rate for Payer: AlohaCare Medicaid	$821.00
Rate for Payer: AlohaCare Medicare	$689.64
Rate for Payer: Cash Price	$1,067.30
Rate for Payer: Cash Price	$1,067.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,510.64
Rate for Payer: Devoted Health Medicare	$689.64
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$186.48
Rate for Payer: Hawaii Medical Service Association Commercial	$259.01
Rate for Payer: Hawaii Medical Service Association Medicare	$689.64
Rate for Payer: Hawaii Western Management Group Commercial	$207.21
Rate for Payer: Health Management Network Commercial	$1,395.70
Rate for Payer: Humana Medicare	$689.64
Rate for Payer: Kaiser Permanente Commercial	$1,477.80
Rate for Payer: Kaiser Permanente Medicaid	$837.42
Rate for Payer: Kaiser Permanente Medicare	$689.64
Rate for Payer: MDX Hawaii PPO	$1,592.74
Rate for Payer: Ohana Health Plan Medicaid	$689.64
Rate for Payer: Ohana Health Plan Medicare	$689.64
Rate for Payer: UnitedHealthcare Medicaid	$186.48
Rate for Payer: UnitedHealthcare Medicare	$689.64
Rate for Payer: University Health Alliance Commercial	$591.56

Know your out-of-pocket cost for care.

All Charges