Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Cannabinoid, Urine Screen FSI

Facility

$1,384.00

Service Code	HCPCS 80307
Hospital Charge Code	8228847
Hospital Revenue Code	301
Min. Negotiated Rate	$1,176.40
Max. Negotiated Rate	$1,342.48
Rate for Payer: Cash Price	$899.60
Rate for Payer: Health Management Network Commercial	$1,176.40
Rate for Payer: Kaiser Permanente Commercial	$1,245.60
Rate for Payer: MDX Hawaii PPO	$1,342.48

CANNULA INNER DISP 5.0MM SHILEY

Facility

$28.00

Hospital Charge Code	8266566
Hospital Revenue Code	270
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$27.16
Rate for Payer: AlohaCare Medicaid	$14.00
Rate for Payer: AlohaCare Medicare	$14.00
Rate for Payer: Cash Price	$18.20
Rate for Payer: Devoted Health Medicare	$15.40
Rate for Payer: Hawaii Medical Service Association Medicare	$14.00
Rate for Payer: Hawaii Western Management Group Commercial	$26.60
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Humana Medicare	$14.00
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$14.28
Rate for Payer: Kaiser Permanente Medicare	$14.00
Rate for Payer: MDX Hawaii PPO	$27.16
Rate for Payer: Ohana Health Plan Medicaid	$14.00
Rate for Payer: Ohana Health Plan Medicare	$14.00
Rate for Payer: UnitedHealthcare Medicare	$14.00
Rate for Payer: University Health Alliance Commercial	$20.41

CANNULA INNER DISP 5.0MM SHILEY

Facility

$28.00

Hospital Charge Code	8266566
Hospital Revenue Code	270
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$18.20
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: MDX Hawaii PPO	$27.16

CANNULA INNER DISP 6.4MM SHILEY

Facility

$28.00

Hospital Charge Code	8266567
Hospital Revenue Code	270
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$18.20
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: MDX Hawaii PPO	$27.16

CANNULA INNER DISP 6.4MM SHILEY

Facility

$28.00

Hospital Charge Code	8266567
Hospital Revenue Code	270
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$27.16
Rate for Payer: AlohaCare Medicaid	$14.00
Rate for Payer: AlohaCare Medicare	$14.00
Rate for Payer: Cash Price	$18.20
Rate for Payer: Devoted Health Medicare	$15.40
Rate for Payer: Hawaii Medical Service Association Medicare	$14.00
Rate for Payer: Hawaii Western Management Group Commercial	$26.60
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Humana Medicare	$14.00
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$14.28
Rate for Payer: Kaiser Permanente Medicare	$14.00
Rate for Payer: MDX Hawaii PPO	$27.16
Rate for Payer: Ohana Health Plan Medicaid	$14.00
Rate for Payer: Ohana Health Plan Medicare	$14.00
Rate for Payer: UnitedHealthcare Medicare	$14.00
Rate for Payer: University Health Alliance Commercial	$20.41

CANNULA INNER DISP 7.6MM SHILEY

Facility

$28.00

Hospital Charge Code	8266568
Hospital Revenue Code	270
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$27.16
Rate for Payer: AlohaCare Medicaid	$14.00
Rate for Payer: AlohaCare Medicare	$14.00
Rate for Payer: Cash Price	$18.20
Rate for Payer: Devoted Health Medicare	$15.40
Rate for Payer: Hawaii Medical Service Association Medicare	$14.00
Rate for Payer: Hawaii Western Management Group Commercial	$26.60
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Humana Medicare	$14.00
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$14.28
Rate for Payer: Kaiser Permanente Medicare	$14.00
Rate for Payer: MDX Hawaii PPO	$27.16
Rate for Payer: Ohana Health Plan Medicaid	$14.00
Rate for Payer: Ohana Health Plan Medicare	$14.00
Rate for Payer: UnitedHealthcare Medicare	$14.00
Rate for Payer: University Health Alliance Commercial	$20.41

CANNULA INNER DISP 7.6MM SHILEY

Facility

$28.00

Hospital Charge Code	8266568
Hospital Revenue Code	270
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$18.20
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: MDX Hawaii PPO	$27.16

CANNULA NASAL INFANT

Facility

$10.00

Hospital Charge Code	8266649
Hospital Revenue Code	270
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$9.70
Rate for Payer: AlohaCare Medicaid	$5.00
Rate for Payer: AlohaCare Medicare	$5.00
Rate for Payer: Cash Price	$6.50
Rate for Payer: Devoted Health Medicare	$5.50
Rate for Payer: Hawaii Medical Service Association Medicare	$5.00
Rate for Payer: Hawaii Western Management Group Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Humana Medicare	$5.00
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: Kaiser Permanente Medicaid	$5.10
Rate for Payer: Kaiser Permanente Medicare	$5.00
Rate for Payer: MDX Hawaii PPO	$9.70
Rate for Payer: Ohana Health Plan Medicaid	$5.00
Rate for Payer: Ohana Health Plan Medicare	$5.00
Rate for Payer: UnitedHealthcare Medicare	$5.00
Rate for Payer: University Health Alliance Commercial	$7.29

CANNULA NASAL INFANT

Facility

$10.00

Hospital Charge Code	8266649
Hospital Revenue Code	270
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.50
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: MDX Hawaii PPO	$9.70

CANNULATED CANCELLOUS SCREW, 7.0X100MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974298
Hospital Revenue Code	278
Min. Negotiated Rate	$259.50
Max. Negotiated Rate	$503.43
Rate for Payer: AlohaCare Medicaid	$259.50
Rate for Payer: AlohaCare Medicare	$259.50
Rate for Payer: Cash Price	$337.35
Rate for Payer: Devoted Health Medicare	$285.45
Rate for Payer: Hawaii Medical Service Association Medicare	$259.50
Rate for Payer: Hawaii Western Management Group Commercial	$363.30
Rate for Payer: Health Management Network Commercial	$441.15
Rate for Payer: Humana Medicare	$259.50
Rate for Payer: Kaiser Permanente Commercial	$467.10
Rate for Payer: Kaiser Permanente Medicaid	$264.69
Rate for Payer: Kaiser Permanente Medicare	$259.50
Rate for Payer: MDX Hawaii PPO	$503.43
Rate for Payer: Ohana Health Plan Medicaid	$259.50
Rate for Payer: Ohana Health Plan Medicare	$259.50
Rate for Payer: UnitedHealthcare Medicare	$259.50
Rate for Payer: University Health Alliance Commercial	$290.64

CANNULATED CANCELLOUS SCREW, 7.0X100MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974298
Hospital Revenue Code	278
Min. Negotiated Rate	$290.64
Max. Negotiated Rate	$503.43
Rate for Payer: Cash Price	$337.35
Rate for Payer: Hawaii Western Management Group Commercial	$363.30
Rate for Payer: Health Management Network Commercial	$441.15
Rate for Payer: Kaiser Permanente Commercial	$467.10
Rate for Payer: MDX Hawaii PPO	$503.43
Rate for Payer: University Health Alliance Commercial	$290.64

CANNULATED CANCELLOUS SCREW, 7.0X105MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974299
Hospital Revenue Code	278
Min. Negotiated Rate	$290.64
Max. Negotiated Rate	$503.43
Rate for Payer: Cash Price	$337.35
Rate for Payer: Hawaii Western Management Group Commercial	$363.30
Rate for Payer: Health Management Network Commercial	$441.15
Rate for Payer: Kaiser Permanente Commercial	$467.10
Rate for Payer: MDX Hawaii PPO	$503.43
Rate for Payer: University Health Alliance Commercial	$290.64

CANNULATED CANCELLOUS SCREW, 7.0X105MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974299
Hospital Revenue Code	278
Min. Negotiated Rate	$259.50
Max. Negotiated Rate	$503.43
Rate for Payer: AlohaCare Medicaid	$259.50
Rate for Payer: AlohaCare Medicare	$259.50
Rate for Payer: Cash Price	$337.35
Rate for Payer: Devoted Health Medicare	$285.45
Rate for Payer: Hawaii Medical Service Association Medicare	$259.50
Rate for Payer: Hawaii Western Management Group Commercial	$363.30
Rate for Payer: Health Management Network Commercial	$441.15
Rate for Payer: Humana Medicare	$259.50
Rate for Payer: Kaiser Permanente Commercial	$467.10
Rate for Payer: Kaiser Permanente Medicaid	$264.69
Rate for Payer: Kaiser Permanente Medicare	$259.50
Rate for Payer: MDX Hawaii PPO	$503.43
Rate for Payer: Ohana Health Plan Medicaid	$259.50
Rate for Payer: Ohana Health Plan Medicare	$259.50
Rate for Payer: UnitedHealthcare Medicare	$259.50
Rate for Payer: University Health Alliance Commercial	$290.64

CANNULATED CANCELLOUS SCREW, 7.0X115MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974292
Hospital Revenue Code	278
Min. Negotiated Rate	$290.64
Max. Negotiated Rate	$503.43
Rate for Payer: Cash Price	$337.35
Rate for Payer: Hawaii Western Management Group Commercial	$363.30
Rate for Payer: Health Management Network Commercial	$441.15
Rate for Payer: Kaiser Permanente Commercial	$467.10
Rate for Payer: MDX Hawaii PPO	$503.43
Rate for Payer: University Health Alliance Commercial	$290.64

CANNULATED CANCELLOUS SCREW, 7.0X115MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974292
Hospital Revenue Code	278
Min. Negotiated Rate	$259.50
Max. Negotiated Rate	$503.43
Rate for Payer: AlohaCare Medicaid	$259.50
Rate for Payer: AlohaCare Medicare	$259.50
Rate for Payer: Cash Price	$337.35
Rate for Payer: Devoted Health Medicare	$285.45
Rate for Payer: Hawaii Medical Service Association Medicare	$259.50
Rate for Payer: Hawaii Western Management Group Commercial	$363.30
Rate for Payer: Health Management Network Commercial	$441.15
Rate for Payer: Humana Medicare	$259.50
Rate for Payer: Kaiser Permanente Commercial	$467.10
Rate for Payer: Kaiser Permanente Medicaid	$264.69
Rate for Payer: Kaiser Permanente Medicare	$259.50
Rate for Payer: MDX Hawaii PPO	$503.43
Rate for Payer: Ohana Health Plan Medicaid	$259.50
Rate for Payer: Ohana Health Plan Medicare	$259.50
Rate for Payer: UnitedHealthcare Medicare	$259.50
Rate for Payer: University Health Alliance Commercial	$290.64

CANNULATED CANCELLOUS SCREW, 7.0X120MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974300
Hospital Revenue Code	278
Min. Negotiated Rate	$290.64
Max. Negotiated Rate	$503.43
Rate for Payer: Cash Price	$337.35
Rate for Payer: Hawaii Western Management Group Commercial	$363.30
Rate for Payer: Health Management Network Commercial	$441.15
Rate for Payer: Kaiser Permanente Commercial	$467.10
Rate for Payer: MDX Hawaii PPO	$503.43
Rate for Payer: University Health Alliance Commercial	$290.64

CANNULATED CANCELLOUS SCREW, 7.0X120MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974300
Hospital Revenue Code	278
Min. Negotiated Rate	$259.50
Max. Negotiated Rate	$503.43
Rate for Payer: AlohaCare Medicaid	$259.50
Rate for Payer: AlohaCare Medicare	$259.50
Rate for Payer: Cash Price	$337.35
Rate for Payer: Devoted Health Medicare	$285.45
Rate for Payer: Hawaii Medical Service Association Medicare	$259.50
Rate for Payer: Hawaii Western Management Group Commercial	$363.30
Rate for Payer: Health Management Network Commercial	$441.15
Rate for Payer: Humana Medicare	$259.50
Rate for Payer: Kaiser Permanente Commercial	$467.10
Rate for Payer: Kaiser Permanente Medicaid	$264.69
Rate for Payer: Kaiser Permanente Medicare	$259.50
Rate for Payer: MDX Hawaii PPO	$503.43
Rate for Payer: Ohana Health Plan Medicaid	$259.50
Rate for Payer: Ohana Health Plan Medicare	$259.50
Rate for Payer: UnitedHealthcare Medicare	$259.50
Rate for Payer: University Health Alliance Commercial	$290.64

CANNULATED CANCELLOUS SCREW, 7.0X125MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974293
Hospital Revenue Code	278
Min. Negotiated Rate	$259.50
Max. Negotiated Rate	$503.43
Rate for Payer: AlohaCare Medicaid	$259.50
Rate for Payer: AlohaCare Medicare	$259.50
Rate for Payer: Cash Price	$337.35
Rate for Payer: Devoted Health Medicare	$285.45
Rate for Payer: Hawaii Medical Service Association Medicare	$259.50
Rate for Payer: Hawaii Western Management Group Commercial	$363.30
Rate for Payer: Health Management Network Commercial	$441.15
Rate for Payer: Humana Medicare	$259.50
Rate for Payer: Kaiser Permanente Commercial	$467.10
Rate for Payer: Kaiser Permanente Medicaid	$264.69
Rate for Payer: Kaiser Permanente Medicare	$259.50
Rate for Payer: MDX Hawaii PPO	$503.43
Rate for Payer: Ohana Health Plan Medicaid	$259.50
Rate for Payer: Ohana Health Plan Medicare	$259.50
Rate for Payer: UnitedHealthcare Medicare	$259.50
Rate for Payer: University Health Alliance Commercial	$290.64

CANNULATED CANCELLOUS SCREW, 7.0X125MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974293
Hospital Revenue Code	278
Min. Negotiated Rate	$290.64
Max. Negotiated Rate	$503.43
Rate for Payer: Cash Price	$337.35
Rate for Payer: Hawaii Western Management Group Commercial	$363.30
Rate for Payer: Health Management Network Commercial	$441.15
Rate for Payer: Kaiser Permanente Commercial	$467.10
Rate for Payer: MDX Hawaii PPO	$503.43
Rate for Payer: University Health Alliance Commercial	$290.64

CANNULATED CANCELLOUS SCREW, 7.0X130MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974296
Hospital Revenue Code	278
Min. Negotiated Rate	$290.64
Max. Negotiated Rate	$503.43
Rate for Payer: Cash Price	$337.35
Rate for Payer: Hawaii Western Management Group Commercial	$363.30
Rate for Payer: Health Management Network Commercial	$441.15
Rate for Payer: Kaiser Permanente Commercial	$467.10
Rate for Payer: MDX Hawaii PPO	$503.43
Rate for Payer: University Health Alliance Commercial	$290.64

CANNULATED CANCELLOUS SCREW, 7.0X130MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974296
Hospital Revenue Code	278
Min. Negotiated Rate	$259.50
Max. Negotiated Rate	$503.43
Rate for Payer: AlohaCare Medicaid	$259.50
Rate for Payer: AlohaCare Medicare	$259.50
Rate for Payer: Cash Price	$337.35
Rate for Payer: Devoted Health Medicare	$285.45
Rate for Payer: Hawaii Medical Service Association Medicare	$259.50
Rate for Payer: Hawaii Western Management Group Commercial	$363.30
Rate for Payer: Health Management Network Commercial	$441.15
Rate for Payer: Humana Medicare	$259.50
Rate for Payer: Kaiser Permanente Commercial	$467.10
Rate for Payer: Kaiser Permanente Medicaid	$264.69
Rate for Payer: Kaiser Permanente Medicare	$259.50
Rate for Payer: MDX Hawaii PPO	$503.43
Rate for Payer: Ohana Health Plan Medicaid	$259.50
Rate for Payer: Ohana Health Plan Medicare	$259.50
Rate for Payer: UnitedHealthcare Medicare	$259.50
Rate for Payer: University Health Alliance Commercial	$290.64

CANNULATED CANCELLOUS SCREW, 7.0X30MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974301
Hospital Revenue Code	278
Min. Negotiated Rate	$259.50
Max. Negotiated Rate	$503.43
Rate for Payer: AlohaCare Medicaid	$259.50
Rate for Payer: AlohaCare Medicare	$259.50
Rate for Payer: Cash Price	$337.35
Rate for Payer: Devoted Health Medicare	$285.45
Rate for Payer: Hawaii Medical Service Association Medicare	$259.50
Rate for Payer: Hawaii Western Management Group Commercial	$363.30
Rate for Payer: Health Management Network Commercial	$441.15
Rate for Payer: Humana Medicare	$259.50
Rate for Payer: Kaiser Permanente Commercial	$467.10
Rate for Payer: Kaiser Permanente Medicaid	$264.69
Rate for Payer: Kaiser Permanente Medicare	$259.50
Rate for Payer: MDX Hawaii PPO	$503.43
Rate for Payer: Ohana Health Plan Medicaid	$259.50
Rate for Payer: Ohana Health Plan Medicare	$259.50
Rate for Payer: UnitedHealthcare Medicare	$259.50
Rate for Payer: University Health Alliance Commercial	$290.64

CANNULATED CANCELLOUS SCREW, 7.0X30MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974301
Hospital Revenue Code	278
Min. Negotiated Rate	$290.64
Max. Negotiated Rate	$503.43
Rate for Payer: Cash Price	$337.35
Rate for Payer: Hawaii Western Management Group Commercial	$363.30
Rate for Payer: Health Management Network Commercial	$441.15
Rate for Payer: Kaiser Permanente Commercial	$467.10
Rate for Payer: MDX Hawaii PPO	$503.43
Rate for Payer: University Health Alliance Commercial	$290.64

CANNULATED CANCELLOUS SCREW, 7.0X35MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974294
Hospital Revenue Code	278
Min. Negotiated Rate	$259.50
Max. Negotiated Rate	$503.43
Rate for Payer: AlohaCare Medicaid	$259.50
Rate for Payer: AlohaCare Medicare	$259.50
Rate for Payer: Cash Price	$337.35
Rate for Payer: Devoted Health Medicare	$285.45
Rate for Payer: Hawaii Medical Service Association Medicare	$259.50
Rate for Payer: Hawaii Western Management Group Commercial	$363.30
Rate for Payer: Health Management Network Commercial	$441.15
Rate for Payer: Humana Medicare	$259.50
Rate for Payer: Kaiser Permanente Commercial	$467.10
Rate for Payer: Kaiser Permanente Medicaid	$264.69
Rate for Payer: Kaiser Permanente Medicare	$259.50
Rate for Payer: MDX Hawaii PPO	$503.43
Rate for Payer: Ohana Health Plan Medicaid	$259.50
Rate for Payer: Ohana Health Plan Medicare	$259.50
Rate for Payer: UnitedHealthcare Medicare	$259.50
Rate for Payer: University Health Alliance Commercial	$290.64

CANNULATED CANCELLOUS SCREW, 7.0X35MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974294
Hospital Revenue Code	278
Min. Negotiated Rate	$290.64
Max. Negotiated Rate	$503.43
Rate for Payer: Cash Price	$337.35
Rate for Payer: Hawaii Western Management Group Commercial	$363.30
Rate for Payer: Health Management Network Commercial	$441.15
Rate for Payer: Kaiser Permanente Commercial	$467.10
Rate for Payer: MDX Hawaii PPO	$503.43
Rate for Payer: University Health Alliance Commercial	$290.64

Know your out-of-pocket cost for care.

All Charges