Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

CT Biopsy Renal

Facility

$3,171.00

Service Code	HCPCS 50200
Hospital Charge Code	1167931
Hospital Revenue Code	350
Min. Negotiated Rate	$2,695.35
Max. Negotiated Rate	$3,075.87
Rate for Payer: Cash Price	$2,061.15
Rate for Payer: Health Management Network Commercial	$2,695.35
Rate for Payer: Kaiser Permanente Commercial	$2,853.90
Rate for Payer: MDX Hawaii PPO	$3,075.87

CT Biopsy Renal - Report

Professional

Both

$995.00

Service Code	HCPCS 50200
Hospital Charge Code	629795
Hospital Revenue Code	972
Min. Negotiated Rate	$110.23
Max. Negotiated Rate	$845.75
Rate for Payer: AlohaCare Medicaid	$125.78
Rate for Payer: AlohaCare Medicare	$110.23
Rate for Payer: Cash Price	$646.75
Rate for Payer: Cash Price	$646.75
Rate for Payer: Devoted Health Medicare	$121.25
Rate for Payer: Hawaii Medical Service Association ABD	$125.78
Rate for Payer: Hawaii Medical Service Association Commercial	$212.59
Rate for Payer: Hawaii Medical Service Association Medicare	$110.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$125.78
Rate for Payer: Hawaii Western Management Group Commercial	$191.88
Rate for Payer: Health Management Network Commercial	$845.75
Rate for Payer: Kaiser Permanente Commercial	$121.25
Rate for Payer: Kaiser Permanente Medicaid	$121.25
Rate for Payer: Kaiser Permanente Medicare	$121.25
Rate for Payer: Ohana Health Plan Medicaid	$125.78
Rate for Payer: Ohana Health Plan Medicare	$110.23
Rate for Payer: UnitedHealthcare Medicaid	$125.78
Rate for Payer: UnitedHealthcare Medicare	$110.23

CT Biopsy Retroperitoneal Abdomen

Facility

$3,181.00

Service Code	HCPCS 49180
Hospital Charge Code	2424740
Hospital Revenue Code	761
Min. Negotiated Rate	$2,703.85
Max. Negotiated Rate	$3,085.57
Rate for Payer: Cash Price	$2,067.65
Rate for Payer: Health Management Network Commercial	$2,703.85
Rate for Payer: Kaiser Permanente Commercial	$2,862.90
Rate for Payer: MDX Hawaii PPO	$3,085.57

CT Biopsy Retroperitoneal Abdomen

Facility

$3,181.00

Service Code	HCPCS 49180
Hospital Charge Code	2424740
Hospital Revenue Code	761
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$672.48
Rate for Payer: AlohaCare Medicare	$1,590.50
Rate for Payer: Cash Price	$2,067.65
Rate for Payer: Cash Price	$2,067.65
Rate for Payer: Devoted Health Medicare	$1,749.55
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,590.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$3,021.95
Rate for Payer: Health Management Network Commercial	$2,703.85
Rate for Payer: Humana Medicare	$1,590.50
Rate for Payer: Kaiser Permanente Commercial	$2,862.90
Rate for Payer: Kaiser Permanente Medicaid	$1,622.31
Rate for Payer: Kaiser Permanente Medicare	$1,590.50
Rate for Payer: MDX Hawaii PPO	$3,085.57
Rate for Payer: Ohana Health Plan Medicaid	$1,590.50
Rate for Payer: Ohana Health Plan Medicare	$1,590.50
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,590.50
Rate for Payer: University Health Alliance Commercial	$2,318.63

CT Bone Density Axial Skeleton

Facility

$574.00

Service Code	HCPCS 77078
Hospital Charge Code	8207915
Hospital Revenue Code	359
Min. Negotiated Rate	$88.91
Max. Negotiated Rate	$556.78
Rate for Payer: AlohaCare Medicaid	$287.00
Rate for Payer: AlohaCare Medicare	$287.00
Rate for Payer: Cash Price	$373.10
Rate for Payer: Cash Price	$373.10
Rate for Payer: Devoted Health Medicare	$315.70
Rate for Payer: Hawaii Medical Service Association ABD	$101.66
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$287.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$106.74
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$487.90
Rate for Payer: Humana Medicare	$287.00
Rate for Payer: Kaiser Permanente Commercial	$516.60
Rate for Payer: Kaiser Permanente Medicaid	$292.74
Rate for Payer: Kaiser Permanente Medicare	$287.00
Rate for Payer: MDX Hawaii PPO	$556.78
Rate for Payer: Ohana Health Plan Medicaid	$287.00
Rate for Payer: Ohana Health Plan Medicare	$287.00
Rate for Payer: UnitedHealthcare Medicaid	$101.66
Rate for Payer: UnitedHealthcare Medicare	$287.00
Rate for Payer: University Health Alliance Commercial	$173.14

CT Bone Density Axial Skeleton

Facility

$574.00

Service Code	HCPCS 77078
Hospital Charge Code	8207915
Hospital Revenue Code	359
Min. Negotiated Rate	$487.90
Max. Negotiated Rate	$556.78
Rate for Payer: Cash Price	$373.10
Rate for Payer: Health Management Network Commercial	$487.90
Rate for Payer: Kaiser Permanente Commercial	$516.60
Rate for Payer: MDX Hawaii PPO	$556.78

CT Bone Density Axial Skeleton - Report

Professional

Both

$121.00

Service Code	HCPCS 77078 26
Hospital Charge Code	8207917
Hospital Revenue Code	972
Min. Negotiated Rate	$11.63
Max. Negotiated Rate	$102.85
Rate for Payer: AlohaCare Medicaid	$70.16
Rate for Payer: AlohaCare Medicare	$11.63
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cash Price	$78.65
Rate for Payer: Devoted Health Medicare	$12.79
Rate for Payer: Hawaii Medical Service Association Medicare	$11.63
Rate for Payer: Hawaii Western Management Group Commercial	$95.71
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Kaiser Permanente Commercial	$12.79
Rate for Payer: Kaiser Permanente Medicaid	$12.79
Rate for Payer: Kaiser Permanente Medicare	$12.79
Rate for Payer: Ohana Health Plan Medicaid	$70.16
Rate for Payer: Ohana Health Plan Medicare	$11.63
Rate for Payer: UnitedHealthcare Medicaid	$70.16
Rate for Payer: UnitedHealthcare Medicare	$11.63

CT Brain/Head w/ Contrast

Facility

$1,555.00

Service Code	HCPCS 70460
Hospital Charge Code	1168092
Hospital Revenue Code	351
Min. Negotiated Rate	$179.20
Max. Negotiated Rate	$1,508.35
Rate for Payer: AlohaCare Medicaid	$777.50
Rate for Payer: AlohaCare Medicare	$777.50
Rate for Payer: Cash Price	$1,010.75
Rate for Payer: Cash Price	$1,010.75
Rate for Payer: Devoted Health Medicare	$855.25
Rate for Payer: Hawaii Medical Service Association ABD	$186.48
Rate for Payer: Hawaii Medical Service Association Commercial	$224.00
Rate for Payer: Hawaii Medical Service Association Medicare	$777.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$202.46
Rate for Payer: Hawaii Western Management Group Commercial	$179.20
Rate for Payer: Health Management Network Commercial	$1,321.75
Rate for Payer: Humana Medicare	$777.50
Rate for Payer: Kaiser Permanente Commercial	$1,399.50
Rate for Payer: Kaiser Permanente Medicaid	$793.05
Rate for Payer: Kaiser Permanente Medicare	$777.50
Rate for Payer: MDX Hawaii PPO	$1,508.35
Rate for Payer: Ohana Health Plan Medicaid	$777.50
Rate for Payer: Ohana Health Plan Medicare	$777.50
Rate for Payer: UnitedHealthcare Medicaid	$186.48
Rate for Payer: UnitedHealthcare Medicare	$777.50
Rate for Payer: University Health Alliance Commercial	$591.56

CT Brain/Head w/ Contrast

Facility

$1,555.00

Service Code	HCPCS 70460
Hospital Charge Code	1168092
Hospital Revenue Code	351
Min. Negotiated Rate	$1,321.75
Max. Negotiated Rate	$1,508.35
Rate for Payer: Cash Price	$1,010.75
Rate for Payer: Health Management Network Commercial	$1,321.75
Rate for Payer: Kaiser Permanente Commercial	$1,399.50
Rate for Payer: MDX Hawaii PPO	$1,508.35

CT Brain/Head w/ Contrast - Report

Professional

Both

$244.00

Service Code	HCPCS 70460 26
Hospital Charge Code	629963
Hospital Revenue Code	972
Min. Negotiated Rate	$52.91
Max. Negotiated Rate	$310.50
Rate for Payer: AlohaCare Medicaid	$100.46
Rate for Payer: AlohaCare Medicare	$52.91
Rate for Payer: Cash Price	$158.60
Rate for Payer: Cash Price	$158.60
Rate for Payer: Devoted Health Medicare	$58.20
Rate for Payer: Hawaii Medical Service Association Medicare	$52.91
Rate for Payer: Hawaii Western Management Group Commercial	$310.50
Rate for Payer: Health Management Network Commercial	$207.40
Rate for Payer: Kaiser Permanente Commercial	$58.20
Rate for Payer: Kaiser Permanente Medicaid	$58.20
Rate for Payer: Kaiser Permanente Medicare	$58.20
Rate for Payer: Ohana Health Plan Medicaid	$100.46
Rate for Payer: Ohana Health Plan Medicare	$52.91
Rate for Payer: UnitedHealthcare Medicaid	$100.46
Rate for Payer: UnitedHealthcare Medicare	$52.91

CT Brain/Head w/o Contrast

Facility

$1,601.00

Service Code	HCPCS 70450
Hospital Charge Code	1168094
Hospital Revenue Code	351
Min. Negotiated Rate	$106.81
Max. Negotiated Rate	$1,552.97
Rate for Payer: AlohaCare Medicaid	$800.50
Rate for Payer: AlohaCare Medicare	$800.50
Rate for Payer: Cash Price	$1,040.65
Rate for Payer: Cash Price	$1,040.65
Rate for Payer: Devoted Health Medicare	$880.55
Rate for Payer: Hawaii Medical Service Association ABD	$139.10
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$800.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$169.03
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$1,360.85
Rate for Payer: Humana Medicare	$800.50
Rate for Payer: Kaiser Permanente Commercial	$1,440.90
Rate for Payer: Kaiser Permanente Medicaid	$816.51
Rate for Payer: Kaiser Permanente Medicare	$800.50
Rate for Payer: MDX Hawaii PPO	$1,552.97
Rate for Payer: Ohana Health Plan Medicaid	$800.50
Rate for Payer: Ohana Health Plan Medicare	$800.50
Rate for Payer: UnitedHealthcare Medicaid	$139.10
Rate for Payer: UnitedHealthcare Medicare	$800.50
Rate for Payer: University Health Alliance Commercial	$465.11

CT Brain/Head w/o Contrast

Facility

$1,601.00

Service Code	HCPCS 70450
Hospital Charge Code	1168094
Hospital Revenue Code	351
Min. Negotiated Rate	$1,360.85
Max. Negotiated Rate	$1,552.97
Rate for Payer: Cash Price	$1,040.65
Rate for Payer: Health Management Network Commercial	$1,360.85
Rate for Payer: Kaiser Permanente Commercial	$1,440.90
Rate for Payer: MDX Hawaii PPO	$1,552.97

CT Brain/Head w/o Contrast - Report

Professional

Both

$155.00

Service Code	HCPCS 70450 26
Hospital Charge Code	629967
Hospital Revenue Code	972
Min. Negotiated Rate	$40.08
Max. Negotiated Rate	$254.45
Rate for Payer: AlohaCare Medicaid	$71.70
Rate for Payer: AlohaCare Medicare	$40.08
Rate for Payer: Cash Price	$100.75
Rate for Payer: Cash Price	$100.75
Rate for Payer: Devoted Health Medicare	$44.09
Rate for Payer: Hawaii Medical Service Association Medicare	$40.08
Rate for Payer: Hawaii Western Management Group Commercial	$254.45
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$44.09
Rate for Payer: Kaiser Permanente Medicaid	$44.09
Rate for Payer: Kaiser Permanente Medicare	$44.09
Rate for Payer: Ohana Health Plan Medicaid	$71.70
Rate for Payer: Ohana Health Plan Medicare	$40.08
Rate for Payer: UnitedHealthcare Medicaid	$71.70
Rate for Payer: UnitedHealthcare Medicare	$40.08

CT Brain/Head w/ + w/o Contrast

Facility

$2,118.00

Service Code	HCPCS 70470
Hospital Charge Code	1168090
Hospital Revenue Code	351
Min. Negotiated Rate	$1,800.30
Max. Negotiated Rate	$2,054.46
Rate for Payer: Cash Price	$1,376.70
Rate for Payer: Health Management Network Commercial	$1,800.30
Rate for Payer: Kaiser Permanente Commercial	$1,906.20
Rate for Payer: MDX Hawaii PPO	$2,054.46

CT Brain/Head w/ + w/o Contrast

Facility

$2,118.00

Service Code	HCPCS 70470
Hospital Charge Code	1168090
Hospital Revenue Code	351
Min. Negotiated Rate	$179.20
Max. Negotiated Rate	$2,054.46
Rate for Payer: AlohaCare Medicaid	$1,059.00
Rate for Payer: AlohaCare Medicare	$1,059.00
Rate for Payer: Cash Price	$1,376.70
Rate for Payer: Cash Price	$1,376.70
Rate for Payer: Devoted Health Medicare	$1,164.90
Rate for Payer: Hawaii Medical Service Association ABD	$232.90
Rate for Payer: Hawaii Medical Service Association Commercial	$224.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,059.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$253.12
Rate for Payer: Hawaii Western Management Group Commercial	$179.20
Rate for Payer: Health Management Network Commercial	$1,800.30
Rate for Payer: Humana Medicare	$1,059.00
Rate for Payer: Kaiser Permanente Commercial	$1,906.20
Rate for Payer: Kaiser Permanente Medicaid	$1,080.18
Rate for Payer: Kaiser Permanente Medicare	$1,059.00
Rate for Payer: MDX Hawaii PPO	$2,054.46
Rate for Payer: Ohana Health Plan Medicaid	$1,059.00
Rate for Payer: Ohana Health Plan Medicare	$1,059.00
Rate for Payer: UnitedHealthcare Medicaid	$232.90
Rate for Payer: UnitedHealthcare Medicare	$1,059.00
Rate for Payer: University Health Alliance Commercial	$718.67

CT Brain/Head w/ + w/o Contrast - Report

Professional

Both

$231.00

Service Code	HCPCS 70470 26
Hospital Charge Code	629959
Hospital Revenue Code	972
Min. Negotiated Rate	$59.48
Max. Negotiated Rate	$380.45
Rate for Payer: AlohaCare Medicaid	$117.71
Rate for Payer: AlohaCare Medicare	$59.48
Rate for Payer: Cash Price	$150.15
Rate for Payer: Cash Price	$150.15
Rate for Payer: Devoted Health Medicare	$65.43
Rate for Payer: Hawaii Medical Service Association Medicare	$59.48
Rate for Payer: Hawaii Western Management Group Commercial	$380.45
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Kaiser Permanente Commercial	$65.43
Rate for Payer: Kaiser Permanente Medicaid	$65.43
Rate for Payer: Kaiser Permanente Medicare	$65.43
Rate for Payer: Ohana Health Plan Medicaid	$117.71
Rate for Payer: Ohana Health Plan Medicare	$59.48
Rate for Payer: UnitedHealthcare Medicaid	$117.71
Rate for Payer: UnitedHealthcare Medicare	$59.48

CT Cath Exchange Abscess/Cyst

Facility

$7,554.00

Service Code	HCPCS 49423
Hospital Charge Code	2424746
Hospital Revenue Code	350
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,327.38
Rate for Payer: AlohaCare Medicaid	$3,777.00
Rate for Payer: AlohaCare Medicare	$3,777.00
Rate for Payer: Cash Price	$4,910.10
Rate for Payer: Cash Price	$4,910.10
Rate for Payer: Devoted Health Medicare	$4,154.70
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,777.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$7,176.30
Rate for Payer: Health Management Network Commercial	$6,420.90
Rate for Payer: Humana Medicare	$3,777.00
Rate for Payer: Kaiser Permanente Commercial	$6,798.60
Rate for Payer: Kaiser Permanente Medicaid	$3,852.54
Rate for Payer: Kaiser Permanente Medicare	$3,777.00
Rate for Payer: MDX Hawaii PPO	$7,327.38
Rate for Payer: Ohana Health Plan Medicaid	$3,777.00
Rate for Payer: Ohana Health Plan Medicare	$3,777.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,777.00
Rate for Payer: University Health Alliance Commercial	$5,506.11

CT Cath Exchange Abscess/Cyst

Facility

$7,554.00

Service Code	HCPCS 49423
Hospital Charge Code	2424746
Hospital Revenue Code	350
Min. Negotiated Rate	$6,420.90
Max. Negotiated Rate	$7,327.38
Rate for Payer: Cash Price	$4,910.10
Rate for Payer: Health Management Network Commercial	$6,420.90
Rate for Payer: Kaiser Permanente Commercial	$6,798.60
Rate for Payer: MDX Hawaii PPO	$7,327.38

CT Cath Exchange Abscess/Cyst - Report

Professional

Both

$2,671.00

Service Code	HCPCS 49423 26
Hospital Charge Code	2424748
Hospital Revenue Code	972
Min. Negotiated Rate	$68.42
Max. Negotiated Rate	$2,270.35
Rate for Payer: AlohaCare Medicaid	$68.42
Rate for Payer: Cash Price	$1,736.15
Rate for Payer: Cash Price	$1,736.15
Rate for Payer: Hawaii Medical Service Association ABD	$68.42
Rate for Payer: Hawaii Medical Service Association Commercial	$115.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$68.42
Rate for Payer: Hawaii Western Management Group Commercial	$91.78
Rate for Payer: Health Management Network Commercial	$2,270.35
Rate for Payer: Ohana Health Plan Medicaid	$68.42
Rate for Payer: UnitedHealthcare Medicaid	$68.42
Rate for Payer: University Health Alliance Commercial	$110.00

CT Cerebral Perfusion Study

Facility

$2,134.00

Service Code	HCPCS 0042T
Hospital Charge Code	1167954
Hospital Revenue Code	350
Min. Negotiated Rate	$1,067.00
Max. Negotiated Rate	$2,069.98
Rate for Payer: AlohaCare Medicaid	$1,067.00
Rate for Payer: AlohaCare Medicare	$1,067.00
Rate for Payer: Cash Price	$1,387.10
Rate for Payer: Devoted Health Medicare	$1,173.70
Rate for Payer: Hawaii Medical Service Association Medicare	$1,067.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,027.30
Rate for Payer: Health Management Network Commercial	$1,813.90
Rate for Payer: Humana Medicare	$1,067.00
Rate for Payer: Kaiser Permanente Commercial	$1,920.60
Rate for Payer: Kaiser Permanente Medicaid	$1,088.34
Rate for Payer: Kaiser Permanente Medicare	$1,067.00
Rate for Payer: MDX Hawaii PPO	$2,069.98
Rate for Payer: Ohana Health Plan Medicaid	$1,067.00
Rate for Payer: Ohana Health Plan Medicare	$1,067.00
Rate for Payer: UnitedHealthcare Medicare	$1,067.00
Rate for Payer: University Health Alliance Commercial	$1,555.47

CT Cerebral Perfusion Study

Facility

$2,134.00

Service Code	HCPCS 0042T
Hospital Charge Code	1167954
Hospital Revenue Code	350
Min. Negotiated Rate	$1,813.90
Max. Negotiated Rate	$2,069.98
Rate for Payer: Cash Price	$1,387.10
Rate for Payer: Health Management Network Commercial	$1,813.90
Rate for Payer: Kaiser Permanente Commercial	$1,920.60
Rate for Payer: MDX Hawaii PPO	$2,069.98

CT Cerebral Perfusion Study - Report

Professional

Both

$438.00

Service Code	HCPCS 0042T
Hospital Charge Code	675645
Hospital Revenue Code	972
Min. Negotiated Rate	$167.44
Max. Negotiated Rate	$372.30
Rate for Payer: Cash Price	$284.70
Rate for Payer: Cash Price	$284.70
Rate for Payer: Hawaii Western Management Group Commercial	$167.44
Rate for Payer: Health Management Network Commercial	$372.30

CT Chest/Abdomen w/ Contrast

Facility

$5,828.00

Service Code	HCPCS 71260
Hospital Charge Code	8099510
Hospital Revenue Code	352
Min. Negotiated Rate	$4,953.80
Max. Negotiated Rate	$5,653.16
Rate for Payer: Cash Price	$3,788.20
Rate for Payer: Health Management Network Commercial	$4,953.80
Rate for Payer: Kaiser Permanente Commercial	$5,245.20
Rate for Payer: MDX Hawaii PPO	$5,653.16

CT Chest/Abdomen w/ Contrast

Facility

$5,828.00

Service Code	HCPCS 71260
Hospital Charge Code	8099510
Hospital Revenue Code	352
Min. Negotiated Rate	$179.20
Max. Negotiated Rate	$5,653.16
Rate for Payer: AlohaCare Medicaid	$2,914.00
Rate for Payer: AlohaCare Medicare	$2,914.00
Rate for Payer: Cash Price	$3,788.20
Rate for Payer: Cash Price	$3,788.20
Rate for Payer: Devoted Health Medicare	$3,205.40
Rate for Payer: Hawaii Medical Service Association ABD	$232.90
Rate for Payer: Hawaii Medical Service Association Commercial	$224.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,914.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$253.12
Rate for Payer: Hawaii Western Management Group Commercial	$179.20
Rate for Payer: Health Management Network Commercial	$4,953.80
Rate for Payer: Humana Medicare	$2,914.00
Rate for Payer: Kaiser Permanente Commercial	$5,245.20
Rate for Payer: Kaiser Permanente Medicaid	$2,972.28
Rate for Payer: Kaiser Permanente Medicare	$2,914.00
Rate for Payer: MDX Hawaii PPO	$5,653.16
Rate for Payer: Ohana Health Plan Medicaid	$2,914.00
Rate for Payer: Ohana Health Plan Medicare	$2,914.00
Rate for Payer: UnitedHealthcare Medicaid	$232.90
Rate for Payer: UnitedHealthcare Medicare	$2,914.00
Rate for Payer: University Health Alliance Commercial	$686.18

CT Chest/Abdomen w/ Contrast - Report

Professional

Both

$284.00

Service Code	HCPCS 71260 26
Hospital Charge Code	8099512
Hospital Revenue Code	972
Min. Negotiated Rate	$54.67
Max. Negotiated Rate	$378.67
Rate for Payer: AlohaCare Medicaid	$113.56
Rate for Payer: AlohaCare Medicare	$54.67
Rate for Payer: Cash Price	$184.60
Rate for Payer: Cash Price	$184.60
Rate for Payer: Devoted Health Medicare	$60.14
Rate for Payer: Hawaii Medical Service Association Medicare	$54.67
Rate for Payer: Hawaii Western Management Group Commercial	$378.67
Rate for Payer: Health Management Network Commercial	$241.40
Rate for Payer: Kaiser Permanente Commercial	$60.14
Rate for Payer: Kaiser Permanente Medicaid	$60.14
Rate for Payer: Kaiser Permanente Medicare	$60.14
Rate for Payer: Ohana Health Plan Medicaid	$113.56
Rate for Payer: Ohana Health Plan Medicare	$54.67
Rate for Payer: UnitedHealthcare Medicaid	$113.56
Rate for Payer: UnitedHealthcare Medicare	$54.67

Know your out-of-pocket cost for care.

All Charges