Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG MRA W/O FOL W/CONT, ABD

Facility

$2,820.00

Service Code	HCPCS 74185
Hospital Charge Code	H6100130
Hospital Revenue Code	610
Min. Negotiated Rate	$369.03
Max. Negotiated Rate	$2,735.40
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Cash Price	$1,833.00
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$401.21
Rate for Payer: Hawaii Western Management Group Commercial	$2,679.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Kaiser Permanente Commercial	$1,776.60
Rate for Payer: Kaiser Permanente Medicaid	$1,438.20
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: University Health Alliance Commercial	$987.38

HCHG MRI BRAIN BRAIN STEM W/CONTR

Facility

$2,261.00

Service Code	HCPCS 70552
Hospital Charge Code	H6110135
Hospital Revenue Code	611
Min. Negotiated Rate	$1,921.85
Max. Negotiated Rate	$2,193.17
Rate for Payer: Cash Price	$1,469.65
Rate for Payer: Health Management Network Commercial	$1,921.85
Rate for Payer: MDX Hawaii PPO	$2,193.17

HCHG MRI BRAIN BRAIN STEM W/CONTR

Facility

$2,261.00

Service Code	HCPCS 70552
Hospital Charge Code	H6110135
Hospital Revenue Code	611
Min. Negotiated Rate	$412.14
Max. Negotiated Rate	$2,193.17
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,469.65
Rate for Payer: Cash Price	$1,469.65
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$442.34
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$480.80
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,921.85
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,424.43
Rate for Payer: Kaiser Permanente Medicaid	$1,153.11
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$2,193.17
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$442.34
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$985.09

HCHG MRI BRAIN WO CONTR

Facility

$2,376.00

Service Code	HCPCS 70551
Hospital Charge Code	H6110110
Hospital Revenue Code	611
Min. Negotiated Rate	$281.87
Max. Negotiated Rate	$2,304.72
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$1,544.40
Rate for Payer: Cash Price	$1,544.40
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$410.54
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$281.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$431.07
Rate for Payer: Hawaii Western Management Group Commercial	$281.87
Rate for Payer: Health Management Network Commercial	$2,019.60
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$1,496.88
Rate for Payer: Kaiser Permanente Medicaid	$1,211.76
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$2,304.72
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$410.54
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$845.58

HCHG MRI BRAIN WO CONTR

Facility

$2,376.00

Service Code	HCPCS 70551
Hospital Charge Code	H6110110
Hospital Revenue Code	611
Min. Negotiated Rate	$2,019.60
Max. Negotiated Rate	$2,304.72
Rate for Payer: Cash Price	$1,544.40
Rate for Payer: Health Management Network Commercial	$2,019.60
Rate for Payer: MDX Hawaii PPO	$2,304.72

HCHG MRI BRAIN W/WO CONTR

Facility

$3,160.00

Service Code	HCPCS 70553
Hospital Charge Code	H6110108
Hospital Revenue Code	611
Min. Negotiated Rate	$2,686.00
Max. Negotiated Rate	$3,065.20
Rate for Payer: Cash Price	$2,054.00
Rate for Payer: Health Management Network Commercial	$2,686.00
Rate for Payer: MDX Hawaii PPO	$3,065.20

HCHG MRI BRAIN W/WO CONTR

Facility

$3,160.00

Service Code	HCPCS 70553
Hospital Charge Code	H6110108
Hospital Revenue Code	611
Min. Negotiated Rate	$412.14
Max. Negotiated Rate	$3,065.20
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$2,054.00
Rate for Payer: Cash Price	$2,054.00
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$879.74
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$923.73
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$2,686.00
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,990.80
Rate for Payer: Kaiser Permanente Medicaid	$1,611.60
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$3,065.20
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$879.74
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$1,297.22

HCHG MRI BREAST C- BILATERAL

Facility

$1,374.00

Service Code	HCPCS 77047
Hospital Charge Code	H6100212
Hospital Revenue Code	610
Min. Negotiated Rate	$1,167.90
Max. Negotiated Rate	$1,332.78
Rate for Payer: Cash Price	$893.10
Rate for Payer: Health Management Network Commercial	$1,167.90
Rate for Payer: MDX Hawaii PPO	$1,332.78

HCHG MRI BREAST C- BILATERAL

Facility

$1,374.00

Service Code	HCPCS 77047
Hospital Charge Code	H6100212
Hospital Revenue Code	610
Min. Negotiated Rate	$148.97
Max. Negotiated Rate	$1,332.78
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$893.10
Rate for Payer: Cash Price	$893.10
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$330.65
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$281.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$395.34
Rate for Payer: Hawaii Western Management Group Commercial	$281.87
Rate for Payer: Health Management Network Commercial	$1,167.90
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$865.62
Rate for Payer: Kaiser Permanente Medicaid	$700.74
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$1,332.78
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$148.97
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$531.88

HCHG MRI BREAST C- UNILATERAL

Facility

$1,374.00

Service Code	HCPCS 77046
Hospital Charge Code	H6100213
Hospital Revenue Code	610
Min. Negotiated Rate	$1,167.90
Max. Negotiated Rate	$1,332.78
Rate for Payer: Cash Price	$893.10
Rate for Payer: Health Management Network Commercial	$1,167.90
Rate for Payer: MDX Hawaii PPO	$1,332.78

HCHG MRI BREAST C- UNILATERAL

Facility

$1,374.00

Service Code	HCPCS 77046
Hospital Charge Code	H6100213
Hospital Revenue Code	610
Min. Negotiated Rate	$145.17
Max. Negotiated Rate	$1,332.78
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$893.10
Rate for Payer: Cash Price	$893.10
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$263.64
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$281.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$294.41
Rate for Payer: Hawaii Western Management Group Commercial	$281.87
Rate for Payer: Health Management Network Commercial	$1,167.90
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$865.62
Rate for Payer: Kaiser Permanente Medicaid	$700.74
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$1,332.78
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$145.17
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$519.17

HCHG MRI BREAST C-+ W/CAD UNI

Facility

$2,536.00

Service Code	HCPCS 77048
Hospital Charge Code	H6100210
Hospital Revenue Code	610
Min. Negotiated Rate	$229.85
Max. Negotiated Rate	$2,459.92
Rate for Payer: Cash Price	$1,648.40
Rate for Payer: Cash Price	$1,648.40
Rate for Payer: Hawaii Medical Service Association ABD	$547.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$634.74
Rate for Payer: Hawaii Western Management Group Commercial	$2,409.20
Rate for Payer: Health Management Network Commercial	$2,155.60
Rate for Payer: Kaiser Permanente Commercial	$1,597.68
Rate for Payer: Kaiser Permanente Medicaid	$1,293.36
Rate for Payer: MDX Hawaii PPO	$2,459.92
Rate for Payer: UnitedHealthcare Medicaid	$229.85
Rate for Payer: University Health Alliance Commercial	$826.67

HCHG MRI BREAST C-+ W/CAD UNI

Facility

$2,536.00

Service Code	HCPCS 77048
Hospital Charge Code	H6100210
Hospital Revenue Code	610
Min. Negotiated Rate	$2,155.60
Max. Negotiated Rate	$2,459.92
Rate for Payer: Cash Price	$1,648.40
Rate for Payer: Health Management Network Commercial	$2,155.60
Rate for Payer: MDX Hawaii PPO	$2,459.92

HCHG MRI EXTREM BONE W/WO CONTR

Facility

$3,102.00

Service Code	HCPCS 73720
Hospital Charge Code	H6100114
Hospital Revenue Code	610
Min. Negotiated Rate	$412.14
Max. Negotiated Rate	$3,008.94
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$2,016.30
Rate for Payer: Cash Price	$2,016.30
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$645.58
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$880.75
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$2,636.70
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,954.26
Rate for Payer: Kaiser Permanente Medicaid	$1,582.02
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$3,008.94
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$645.58
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$1,285.82

HCHG MRI EXTREM BONE W/WO CONTR

Facility

$3,102.00

Service Code	HCPCS 73720
Hospital Charge Code	H6100114
Hospital Revenue Code	610
Min. Negotiated Rate	$2,636.70
Max. Negotiated Rate	$3,008.94
Rate for Payer: Cash Price	$2,016.30
Rate for Payer: Health Management Network Commercial	$2,636.70
Rate for Payer: MDX Hawaii PPO	$3,008.94

HCHG MRI FACE/SALIV W/WO CONTR

Facility

$3,102.00

Service Code	HCPCS 70543
Hospital Charge Code	H6110114
Hospital Revenue Code	611
Min. Negotiated Rate	$412.14
Max. Negotiated Rate	$3,008.94
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$2,016.30
Rate for Payer: Cash Price	$2,016.30
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$983.00
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$952.52
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$2,636.70
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,954.26
Rate for Payer: Kaiser Permanente Medicaid	$1,582.02
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$3,008.94
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$983.00
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$1,285.82

HCHG MRI FACE/SALIV W/WO CONTR

Facility

$3,102.00

Service Code	HCPCS 70543
Hospital Charge Code	H6110114
Hospital Revenue Code	611
Min. Negotiated Rate	$2,636.70
Max. Negotiated Rate	$3,008.94
Rate for Payer: Cash Price	$2,016.30
Rate for Payer: Health Management Network Commercial	$2,636.70
Rate for Payer: MDX Hawaii PPO	$3,008.94

HCHG MRI FACE/SALV GLAND BILAT

Facility

$1,946.00

Service Code	HCPCS 70540
Hospital Charge Code	H6110116
Hospital Revenue Code	611
Min. Negotiated Rate	$281.87
Max. Negotiated Rate	$1,887.62
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$1,264.90
Rate for Payer: Cash Price	$1,264.90
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$369.03
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$281.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$393.81
Rate for Payer: Hawaii Western Management Group Commercial	$281.87
Rate for Payer: Health Management Network Commercial	$1,654.10
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$1,225.98
Rate for Payer: Kaiser Permanente Medicaid	$992.46
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$1,887.62
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$369.03
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$837.87

HCHG MRI FACE/SALV GLAND BILAT

Facility

$1,946.00

Service Code	HCPCS 70540
Hospital Charge Code	H6110116
Hospital Revenue Code	611
Min. Negotiated Rate	$1,654.10
Max. Negotiated Rate	$1,887.62
Rate for Payer: Cash Price	$1,264.90
Rate for Payer: Health Management Network Commercial	$1,654.10
Rate for Payer: MDX Hawaii PPO	$1,887.62

HCHG MRI KNEE RT/LT W/O CONTRAST

Facility

$2,342.00

Service Code	HCPCS 73721
Hospital Charge Code	H6100170
Hospital Revenue Code	610
Min. Negotiated Rate	$1,990.70
Max. Negotiated Rate	$2,271.74
Rate for Payer: Cash Price	$1,522.30
Rate for Payer: Health Management Network Commercial	$1,990.70
Rate for Payer: MDX Hawaii PPO	$2,271.74

HCHG MRI KNEE RT/LT W/O CONTRAST

Facility

$2,342.00

Service Code	HCPCS 73721
Hospital Charge Code	H6100170
Hospital Revenue Code	610
Min. Negotiated Rate	$281.87
Max. Negotiated Rate	$2,271.74
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$1,522.30
Rate for Payer: Cash Price	$1,522.30
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$396.10
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$281.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$415.91
Rate for Payer: Hawaii Western Management Group Commercial	$281.87
Rate for Payer: Health Management Network Commercial	$1,990.70
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$1,475.46
Rate for Payer: Kaiser Permanente Medicaid	$1,194.42
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$2,271.74
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$396.10
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$837.57

HCHG MRI LOWER EXTREMITY W/DYE

Facility

$2,261.00

Service Code	HCPCS 73719
Hospital Charge Code	H6100217
Hospital Revenue Code	610
Min. Negotiated Rate	$382.28
Max. Negotiated Rate	$2,193.17
Rate for Payer: AlohaCare Medicaid	$412.14
Rate for Payer: AlohaCare Medicare	$412.14
Rate for Payer: Cash Price	$1,469.65
Rate for Payer: Cash Price	$1,469.65
Rate for Payer: Devoted Health Medicare	$453.35
Rate for Payer: Hawaii Medical Service Association ABD	$382.28
Rate for Payer: Hawaii Medical Service Association Commercial	$515.17
Rate for Payer: Hawaii Medical Service Association Medicare	$412.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$475.88
Rate for Payer: Hawaii Western Management Group Commercial	$412.14
Rate for Payer: Health Management Network Commercial	$1,921.85
Rate for Payer: Humana Medicare	$412.14
Rate for Payer: Kaiser Permanente Commercial	$1,424.43
Rate for Payer: Kaiser Permanente Medicaid	$1,153.11
Rate for Payer: Kaiser Permanente Medicare	$412.14
Rate for Payer: MDX Hawaii PPO	$2,193.17
Rate for Payer: Ohana Health Plan Medicaid	$453.35
Rate for Payer: Ohana Health Plan Medicare	$412.14
Rate for Payer: UnitedHealthcare Medicaid	$382.28
Rate for Payer: UnitedHealthcare Medicare	$412.14
Rate for Payer: University Health Alliance Commercial	$974.25

HCHG MRI LOWER EXTREMITY W/DYE

Facility

$2,261.00

Service Code	HCPCS 73719
Hospital Charge Code	H6100217
Hospital Revenue Code	610
Min. Negotiated Rate	$1,921.85
Max. Negotiated Rate	$2,193.17
Rate for Payer: Cash Price	$1,469.65
Rate for Payer: Health Management Network Commercial	$1,921.85
Rate for Payer: MDX Hawaii PPO	$2,193.17

HCHG MRI LOW EXT NOT JOINT W/O CONT

Facility

$2,141.00

Service Code	HCPCS 73718
Hospital Charge Code	H6100116
Hospital Revenue Code	610
Min. Negotiated Rate	$281.87
Max. Negotiated Rate	$2,076.77
Rate for Payer: AlohaCare Medicaid	$281.87
Rate for Payer: AlohaCare Medicare	$281.87
Rate for Payer: Cash Price	$1,391.65
Rate for Payer: Cash Price	$1,391.65
Rate for Payer: Devoted Health Medicare	$310.06
Rate for Payer: Hawaii Medical Service Association ABD	$318.66
Rate for Payer: Hawaii Medical Service Association Commercial	$352.34
Rate for Payer: Hawaii Medical Service Association Medicare	$281.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$396.79
Rate for Payer: Hawaii Western Management Group Commercial	$281.87
Rate for Payer: Health Management Network Commercial	$1,819.85
Rate for Payer: Humana Medicare	$281.87
Rate for Payer: Kaiser Permanente Commercial	$1,348.83
Rate for Payer: Kaiser Permanente Medicaid	$1,091.91
Rate for Payer: Kaiser Permanente Medicare	$281.87
Rate for Payer: MDX Hawaii PPO	$2,076.77
Rate for Payer: Ohana Health Plan Medicaid	$310.06
Rate for Payer: Ohana Health Plan Medicare	$281.87
Rate for Payer: UnitedHealthcare Medicaid	$318.66
Rate for Payer: UnitedHealthcare Medicare	$281.87
Rate for Payer: University Health Alliance Commercial	$837.87

HCHG MRI LOW EXT NOT JOINT W/O CONT

Facility

$2,141.00

Service Code	HCPCS 73718
Hospital Charge Code	H6100116
Hospital Revenue Code	610
Min. Negotiated Rate	$1,819.85
Max. Negotiated Rate	$2,076.77
Rate for Payer: Cash Price	$1,391.65
Rate for Payer: Health Management Network Commercial	$1,819.85
Rate for Payer: MDX Hawaii PPO	$2,076.77

Know your out-of-pocket cost for care.

All Charges