Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

69210-Cerumen w/ Instrumentation

Facility

$330.00

Service Code	HCPCS 69210
Hospital Charge Code	8080150
Hospital Revenue Code	450
Min. Negotiated Rate	$280.50
Max. Negotiated Rate	$320.10
Rate for Payer: Cash Price	$214.50
Rate for Payer: Health Management Network Commercial	$280.50
Rate for Payer: Kaiser Permanente Commercial	$297.00
Rate for Payer: MDX Hawaii PPO	$320.10

69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT TechFee

Facility

$301.00

Service Code	HCPCS 69210
Hospital Charge Code	8211356
Hospital Revenue Code	450
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

69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT TechFee

Facility

$301.00

Service Code	HCPCS 69210
Hospital Charge Code	8211356
Hospital Revenue Code	450
Min. Negotiated Rate	$150.50
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$150.50
Rate for Payer: Cash Price	$195.65
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	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$150.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$285.95
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	$937.50
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 Medicare	$150.50
Rate for Payer: University Health Alliance Commercial	$5,160.40

70470 CT HEAD/BRN C-/C+ ProFee

Professional

Both

$241.00

Service Code	HCPCS 70470 26
Hospital Charge Code	8102599
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	$156.65
Rate for Payer: Cash Price	$156.65
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	$204.85
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

70486 - add on

Facility

$4,657.00

Service Code	HCPCS 70486
Hospital Charge Code	12231525
Hospital Revenue Code	351
Min. Negotiated Rate	$3,958.45
Max. Negotiated Rate	$4,517.29
Rate for Payer: Cash Price	$3,027.05
Rate for Payer: Health Management Network Commercial	$3,958.45
Rate for Payer: Kaiser Permanente Commercial	$4,191.30
Rate for Payer: MDX Hawaii PPO	$4,517.29

70486 - add on

Facility

$4,657.00

Service Code	HCPCS 70486
Hospital Charge Code	12231525
Hospital Revenue Code	351
Min. Negotiated Rate	$106.81
Max. Negotiated Rate	$4,517.29
Rate for Payer: AlohaCare Medicaid	$2,328.50
Rate for Payer: AlohaCare Medicare	$2,328.50
Rate for Payer: Cash Price	$3,027.05
Rate for Payer: Cash Price	$3,027.05
Rate for Payer: Devoted Health Medicare	$2,561.35
Rate for Payer: Hawaii Medical Service Association ABD	$155.53
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$2,328.50
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	$3,958.45
Rate for Payer: Humana Medicare	$2,328.50
Rate for Payer: Kaiser Permanente Commercial	$4,191.30
Rate for Payer: Kaiser Permanente Medicaid	$2,375.07
Rate for Payer: Kaiser Permanente Medicare	$2,328.50
Rate for Payer: MDX Hawaii PPO	$4,517.29
Rate for Payer: Ohana Health Plan Medicaid	$2,328.50
Rate for Payer: Ohana Health Plan Medicare	$2,328.50
Rate for Payer: UnitedHealthcare Medicaid	$155.53
Rate for Payer: UnitedHealthcare Medicare	$2,328.50
Rate for Payer: University Health Alliance Commercial	$500.94

70486 - add on report

Professional

Both

$218.00

Service Code	HCPCS 70486
Hospital Charge Code	12221352
Hospital Revenue Code	972
Min. Negotiated Rate	$87.30
Max. Negotiated Rate	$269.56
Rate for Payer: AlohaCare Medicaid	$87.30
Rate for Payer: AlohaCare Medicare	$140.91
Rate for Payer: Cash Price	$141.70
Rate for Payer: Cash Price	$141.70
Rate for Payer: Devoted Health Medicare	$155.00
Rate for Payer: Hawaii Medical Service Association Medicare	$140.91
Rate for Payer: Hawaii Western Management Group Commercial	$269.56
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Kaiser Permanente Commercial	$155.00
Rate for Payer: Kaiser Permanente Medicaid	$155.00
Rate for Payer: Kaiser Permanente Medicare	$155.00
Rate for Payer: Ohana Health Plan Medicaid	$87.30
Rate for Payer: Ohana Health Plan Medicare	$140.91
Rate for Payer: UnitedHealthcare Medicaid	$87.30
Rate for Payer: UnitedHealthcare Medicare	$140.91

70491 - add on

Facility

$5,408.00

Service Code	HCPCS 70491
Hospital Charge Code	12221351
Hospital Revenue Code	351
Min. Negotiated Rate	$179.20
Max. Negotiated Rate	$5,245.76
Rate for Payer: AlohaCare Medicaid	$2,704.00
Rate for Payer: AlohaCare Medicare	$2,704.00
Rate for Payer: Cash Price	$3,515.20
Rate for Payer: Cash Price	$3,515.20
Rate for Payer: Devoted Health Medicare	$2,974.40
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	$2,704.00
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	$4,596.80
Rate for Payer: Humana Medicare	$2,704.00
Rate for Payer: Kaiser Permanente Commercial	$4,867.20
Rate for Payer: Kaiser Permanente Medicaid	$2,758.08
Rate for Payer: Kaiser Permanente Medicare	$2,704.00
Rate for Payer: MDX Hawaii PPO	$5,245.76
Rate for Payer: Ohana Health Plan Medicaid	$2,704.00
Rate for Payer: Ohana Health Plan Medicare	$2,704.00
Rate for Payer: UnitedHealthcare Medicaid	$186.48
Rate for Payer: UnitedHealthcare Medicare	$2,704.00
Rate for Payer: University Health Alliance Commercial	$671.68

70491 - add on

Facility

$5,408.00

Service Code	HCPCS 70491
Hospital Charge Code	12221351
Hospital Revenue Code	351
Min. Negotiated Rate	$4,596.80
Max. Negotiated Rate	$5,245.76
Rate for Payer: Cash Price	$3,515.20
Rate for Payer: Health Management Network Commercial	$4,596.80
Rate for Payer: Kaiser Permanente Commercial	$4,867.20
Rate for Payer: MDX Hawaii PPO	$5,245.76

70491 - add on report

Professional

Both

$312.00

Service Code	HCPCS 70491
Hospital Charge Code	12241245
Hospital Revenue Code	972
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$323.80
Rate for Payer: AlohaCare Medicaid	$124.95
Rate for Payer: AlohaCare Medicare	$200.64
Rate for Payer: Cash Price	$202.80
Rate for Payer: Cash Price	$202.80
Rate for Payer: Devoted Health Medicare	$220.70
Rate for Payer: Hawaii Medical Service Association Medicare	$200.64
Rate for Payer: Hawaii Western Management Group Commercial	$323.80
Rate for Payer: Health Management Network Commercial	$265.20
Rate for Payer: Kaiser Permanente Commercial	$220.70
Rate for Payer: Kaiser Permanente Medicaid	$220.70
Rate for Payer: Kaiser Permanente Medicare	$220.70
Rate for Payer: Ohana Health Plan Medicaid	$124.95
Rate for Payer: Ohana Health Plan Medicare	$200.64
Rate for Payer: UnitedHealthcare Medicaid	$124.95
Rate for Payer: UnitedHealthcare Medicare	$200.64

70492 - add on

Facility

$5,798.00

Service Code	HCPCS 70492
Hospital Charge Code	12221349
Hospital Revenue Code	351
Min. Negotiated Rate	$179.20
Max. Negotiated Rate	$5,624.06
Rate for Payer: AlohaCare Medicaid	$2,899.00
Rate for Payer: AlohaCare Medicare	$2,899.00
Rate for Payer: Cash Price	$3,768.70
Rate for Payer: Cash Price	$3,768.70
Rate for Payer: Devoted Health Medicare	$3,188.90
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	$2,899.00
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	$4,928.30
Rate for Payer: Humana Medicare	$2,899.00
Rate for Payer: Kaiser Permanente Commercial	$5,218.20
Rate for Payer: Kaiser Permanente Medicaid	$2,956.98
Rate for Payer: Kaiser Permanente Medicare	$2,899.00
Rate for Payer: MDX Hawaii PPO	$5,624.06
Rate for Payer: Ohana Health Plan Medicaid	$2,899.00
Rate for Payer: Ohana Health Plan Medicare	$2,899.00
Rate for Payer: UnitedHealthcare Medicaid	$186.48
Rate for Payer: UnitedHealthcare Medicare	$2,899.00
Rate for Payer: University Health Alliance Commercial	$807.15

70492 - add on

Facility

$5,798.00

Service Code	HCPCS 70492
Hospital Charge Code	12221349
Hospital Revenue Code	351
Min. Negotiated Rate	$4,928.30
Max. Negotiated Rate	$5,624.06
Rate for Payer: Cash Price	$3,768.70
Rate for Payer: Health Management Network Commercial	$4,928.30
Rate for Payer: Kaiser Permanente Commercial	$5,218.20
Rate for Payer: MDX Hawaii PPO	$5,624.06

70492 - add on report

Professional

Both

$375.00

Service Code	HCPCS 70492
Hospital Charge Code	12221350
Hospital Revenue Code	972
Min. Negotiated Rate	$150.05
Max. Negotiated Rate	$389.90
Rate for Payer: AlohaCare Medicaid	$150.05
Rate for Payer: AlohaCare Medicare	$240.79
Rate for Payer: Cash Price	$243.75
Rate for Payer: Cash Price	$243.75
Rate for Payer: Devoted Health Medicare	$264.87
Rate for Payer: Hawaii Medical Service Association Medicare	$240.79
Rate for Payer: Hawaii Western Management Group Commercial	$389.90
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: Kaiser Permanente Commercial	$264.87
Rate for Payer: Kaiser Permanente Medicaid	$264.87
Rate for Payer: Kaiser Permanente Medicare	$264.87
Rate for Payer: Ohana Health Plan Medicaid	$150.05
Rate for Payer: Ohana Health Plan Medicare	$240.79
Rate for Payer: UnitedHealthcare Medicaid	$150.05
Rate for Payer: UnitedHealthcare Medicare	$240.79

7.0MM FLAT WASHER

Facility

$105.00

Hospital Charge Code	12969395
Hospital Revenue Code	272
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$68.25
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: MDX Hawaii PPO	$101.85

7.0MM FLAT WASHER

Facility

$105.00

Hospital Charge Code	12969395
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$101.85
Rate for Payer: AlohaCare Medicaid	$52.50
Rate for Payer: AlohaCare Medicare	$52.50
Rate for Payer: Cash Price	$68.25
Rate for Payer: Devoted Health Medicare	$57.75
Rate for Payer: Hawaii Medical Service Association Medicare	$52.50
Rate for Payer: Hawaii Western Management Group Commercial	$99.75
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Humana Medicare	$52.50
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Medicaid	$53.55
Rate for Payer: Kaiser Permanente Medicare	$52.50
Rate for Payer: MDX Hawaii PPO	$101.85
Rate for Payer: Ohana Health Plan Medicaid	$52.50
Rate for Payer: Ohana Health Plan Medicare	$52.50
Rate for Payer: UnitedHealthcare Medicare	$52.50
Rate for Payer: University Health Alliance Commercial	$76.53

71045 RADIOLOGIC EXAM CHEST SINGLE VIEW ProFee

Professional

Both

$121.00

Service Code	HCPCS 71045
Hospital Charge Code	8102638
Hospital Revenue Code	972
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$102.85
Rate for Payer: AlohaCare Medicaid	$16.90
Rate for Payer: AlohaCare Medicare	$27.67
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cash Price	$78.65
Rate for Payer: Devoted Health Medicare	$30.44
Rate for Payer: Hawaii Medical Service Association Medicare	$27.67
Rate for Payer: Hawaii Western Management Group Commercial	$34.57
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Kaiser Permanente Commercial	$30.44
Rate for Payer: Kaiser Permanente Medicaid	$30.44
Rate for Payer: Kaiser Permanente Medicare	$30.44
Rate for Payer: Ohana Health Plan Medicaid	$16.90
Rate for Payer: Ohana Health Plan Medicare	$27.67
Rate for Payer: UnitedHealthcare Medicaid	$16.90
Rate for Payer: UnitedHealthcare Medicare	$27.67

71046 RADIOLOGIC EXAM CHEST 2 VIEWS ProFee

Professional

Both

$121.00

Service Code	HCPCS 71046
Hospital Charge Code	8102639
Hospital Revenue Code	972
Min. Negotiated Rate	$22.29
Max. Negotiated Rate	$102.85
Rate for Payer: AlohaCare Medicaid	$22.29
Rate for Payer: AlohaCare Medicare	$36.26
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cash Price	$78.65
Rate for Payer: Devoted Health Medicare	$39.89
Rate for Payer: Hawaii Medical Service Association Medicare	$36.26
Rate for Payer: Hawaii Western Management Group Commercial	$39.25
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Kaiser Permanente Commercial	$39.89
Rate for Payer: Kaiser Permanente Medicaid	$39.89
Rate for Payer: Kaiser Permanente Medicare	$39.89
Rate for Payer: Ohana Health Plan Medicaid	$22.29
Rate for Payer: Ohana Health Plan Medicare	$36.26
Rate for Payer: UnitedHealthcare Medicaid	$22.29
Rate for Payer: UnitedHealthcare Medicare	$36.26

71250 - CT Chest/Abdomen

Facility

$4,747.00

Service Code	HCPCS 71250
Hospital Charge Code	12231023
Hospital Revenue Code	351
Min. Negotiated Rate	$106.81
Max. Negotiated Rate	$4,604.59
Rate for Payer: AlohaCare Medicaid	$2,373.50
Rate for Payer: AlohaCare Medicare	$2,373.50
Rate for Payer: Cash Price	$3,085.55
Rate for Payer: Cash Price	$3,085.55
Rate for Payer: Devoted Health Medicare	$2,610.85
Rate for Payer: Hawaii Medical Service Association ABD	$194.84
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$2,373.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$211.43
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$4,034.95
Rate for Payer: Humana Medicare	$2,373.50
Rate for Payer: Kaiser Permanente Commercial	$4,272.30
Rate for Payer: Kaiser Permanente Medicaid	$2,420.97
Rate for Payer: Kaiser Permanente Medicare	$2,373.50
Rate for Payer: MDX Hawaii PPO	$4,604.59
Rate for Payer: Ohana Health Plan Medicaid	$2,373.50
Rate for Payer: Ohana Health Plan Medicare	$2,373.50
Rate for Payer: UnitedHealthcare Medicaid	$194.84
Rate for Payer: UnitedHealthcare Medicare	$2,373.50
Rate for Payer: University Health Alliance Commercial	$502.27

71250 - CT Chest/Abdomen

Facility

$4,747.00

Service Code	HCPCS 71250
Hospital Charge Code	12231023
Hospital Revenue Code	351
Min. Negotiated Rate	$4,034.95
Max. Negotiated Rate	$4,604.59
Rate for Payer: Cash Price	$3,085.55
Rate for Payer: Health Management Network Commercial	$4,034.95
Rate for Payer: Kaiser Permanente Commercial	$4,272.30
Rate for Payer: MDX Hawaii PPO	$4,604.59

71250 - CT Chest/Abdomen report

Professional

Both

$225.00

Service Code	HCPCS 71250
Hospital Charge Code	12221169
Hospital Revenue Code	972
Min. Negotiated Rate	$89.82
Max. Negotiated Rate	$322.87
Rate for Payer: AlohaCare Medicaid	$89.82
Rate for Payer: AlohaCare Medicare	$144.66
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Devoted Health Medicare	$159.13
Rate for Payer: Hawaii Medical Service Association Medicare	$144.66
Rate for Payer: Hawaii Western Management Group Commercial	$322.87
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$159.13
Rate for Payer: Kaiser Permanente Medicaid	$159.13
Rate for Payer: Kaiser Permanente Medicare	$159.13
Rate for Payer: Ohana Health Plan Medicaid	$89.82
Rate for Payer: Ohana Health Plan Medicare	$144.66
Rate for Payer: UnitedHealthcare Medicaid	$89.82
Rate for Payer: UnitedHealthcare Medicare	$144.66

71260 - CT Chest/Abdomen

Facility

$5,828.00

Service Code	HCPCS 71260
Hospital Charge Code	12231022
Hospital Revenue Code	351
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

71260 - CT Chest/Abdomen

Facility

$5,828.00

Service Code	HCPCS 71260
Hospital Charge Code	12231022
Hospital Revenue Code	351
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

71260 - CT Chest/Abdomen report

Professional

Both

$284.00

Service Code	HCPCS 71260
Hospital Charge Code	12221170
Hospital Revenue Code	972
Min. Negotiated Rate	$113.56
Max. Negotiated Rate	$378.67
Rate for Payer: AlohaCare Medicaid	$113.56
Rate for Payer: AlohaCare Medicare	$182.66
Rate for Payer: Cash Price	$184.60
Rate for Payer: Cash Price	$184.60
Rate for Payer: Devoted Health Medicare	$200.93
Rate for Payer: Hawaii Medical Service Association Medicare	$182.66
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	$200.93
Rate for Payer: Kaiser Permanente Medicaid	$200.93
Rate for Payer: Kaiser Permanente Medicare	$200.93
Rate for Payer: Ohana Health Plan Medicaid	$113.56
Rate for Payer: Ohana Health Plan Medicare	$182.66
Rate for Payer: UnitedHealthcare Medicaid	$113.56
Rate for Payer: UnitedHealthcare Medicare	$182.66

71270 - CT Chest/Abdomen

Facility

$6,414.00

Service Code	HCPCS 71270
Hospital Charge Code	12220860
Hospital Revenue Code	351
Min. Negotiated Rate	$5,451.90
Max. Negotiated Rate	$6,221.58
Rate for Payer: Cash Price	$4,169.10
Rate for Payer: Health Management Network Commercial	$5,451.90
Rate for Payer: Kaiser Permanente Commercial	$5,772.60
Rate for Payer: MDX Hawaii PPO	$6,221.58

71270 - CT Chest/Abdomen

Facility

$6,414.00

Service Code	HCPCS 71270
Hospital Charge Code	12220860
Hospital Revenue Code	351
Min. Negotiated Rate	$179.20
Max. Negotiated Rate	$6,221.58
Rate for Payer: AlohaCare Medicaid	$3,207.00
Rate for Payer: AlohaCare Medicare	$3,207.00
Rate for Payer: Cash Price	$4,169.10
Rate for Payer: Cash Price	$4,169.10
Rate for Payer: Devoted Health Medicare	$3,527.70
Rate for Payer: Hawaii Medical Service Association ABD	$291.10
Rate for Payer: Hawaii Medical Service Association Commercial	$224.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,207.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$316.52
Rate for Payer: Hawaii Western Management Group Commercial	$179.20
Rate for Payer: Health Management Network Commercial	$5,451.90
Rate for Payer: Humana Medicare	$3,207.00
Rate for Payer: Kaiser Permanente Commercial	$5,772.60
Rate for Payer: Kaiser Permanente Medicaid	$3,271.14
Rate for Payer: Kaiser Permanente Medicare	$3,207.00
Rate for Payer: MDX Hawaii PPO	$6,221.58
Rate for Payer: Ohana Health Plan Medicaid	$3,207.00
Rate for Payer: Ohana Health Plan Medicare	$3,207.00
Rate for Payer: UnitedHealthcare Medicaid	$291.10
Rate for Payer: UnitedHealthcare Medicare	$3,207.00
Rate for Payer: University Health Alliance Commercial	$799.87

Know your out-of-pocket cost for care.

All Charges