Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

CANCELLOUS SCREW, CAPTURED, FT,6.5X80MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971002
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, FT,6.5X85MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971013
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, FT,6.5X85MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971013
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, FT,6.5X90MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971007
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, FT,6.5X90MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971007
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, FT,6.5X95MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971014
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, FT,6.5X95MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971014
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X100MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971003
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X100MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971003
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X105MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971015
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X105MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971015
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X110MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971008
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X110MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971008
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X115MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971009
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X115MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971009
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X120MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971010
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X120MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971010
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X30MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971011
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X30MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12971011
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X35MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974102
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X35MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974102
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X40MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974096
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X40MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974096
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X45MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974097
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CANCELLOUS SCREW, CAPTURED, PT,6.0X45MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12974097
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

Know your out-of-pocket cost for care.

All Charges