This referral does not require charity care.
For patients with contrast allergies: Premedication_Instructions
BEFORE ordering this imaging test, review the following conditions and follow the special instructions:
The patient is 65 years or older OR has DIABETES, KIDNEY disease, LIVER disease, or other significant medical conditions
The patient has chronic kidney disease and the CT scan will require IV CONTRAST
The patient has an ALLERGY to IV contrast (MUST review "Allergies" tab before placing order!)
The patient is a FEMALE of reproductive age
Access to Care Team
Please keep the Radiology Referrals Manager updated regarding obtaining charity care for the patient.
Cost to EHHOP Patient: For EHHOP patients, the CT scan will cost $20 per body part regardless of charity care status, whether contrast is used, or which body part is scanned. Patients must bring the EHHOP voucher to the appointment to indicate they are from EHHOP.
If the scan is urgent or the patient has charity care levels 1 or 2, EHHOP will pay the bill. The cost of the scan should be filled out as amount authorized for transfer on the voucher form.
If the patient has above charity care level 2, the patient will pay the bill and will need to bring the cost of the scan to the appointment. The patient will still need to bring the voucher to indicate the patient is from EHHOP but the amount authorized for transfer is $0.
Please contact the Radiology Referrals Manager with any questions.
1176 5th Avenue, Annenberg Building, MC level (the basement of Annenberg)
Monday - Friday: 8:30 am - 3:30 pm
Radiology Referrals Manager: Alex Miner