Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

CANNULATED CANCELLOUS SCREW, 7.0X40MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974302
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, 7.0X40MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974302
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, 7.0X45MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974297
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, 7.0X45MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974297
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, 7.0X50MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974303
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, 7.0X50MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974303
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, 7.0X55MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12971170
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, 7.0X55MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12971170
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, 7.0X60MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12971171
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, 7.0X60MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12971171
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, 7.0X65MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12971172
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, 7.0X65MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12971172
Hospital Revenue Code	278
Min. Negotiated Rate	$259.50
Max. Negotiated Rate	$503.43
Rate for Payer: Kaiser Permanente Medicare	$259.50
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: 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, 7.0X70MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12971173
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, 7.0X70MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12971173
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, 7.0X90MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974371
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, 7.0X90MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974371
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, 7.0X95MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974364
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, 7.0X95MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974364
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 CANC SCREW,36MM THD,7.0X100MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974204
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 CANC SCREW,36MM THD,7.0X100MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974204
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 CANC SCREW,36MM THD,7.0X105MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974205
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 CANC SCREW,36MM THD,7.0X105MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974205
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 CANC SCREW,36MM THD,7.0X110MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974200
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 CANC SCREW,36MM THD,7.0X110MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974200
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 CANC SCREW,36MM THD,7.0X115MM

Facility

$519.00

Service Code	HCPCS C1713
Hospital Charge Code	12974201
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