Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$43,547.17

Service Code	MSDRG 324
Min. Negotiated Rate	$43,547.17
Max. Negotiated Rate	$43,547.17
Rate for Payer: Hawaii Medical Service Association Commercial	$43,547.17

CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE

Facility

$40,997.57

Service Code	MSDRG 325
Min. Negotiated Rate	$40,997.57
Max. Negotiated Rate	$40,997.57
Rate for Payer: Hawaii Medical Service Association Commercial	$40,997.57

CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH DOUBLE OSTEOTOMY, ANY METHOD

Facility

$11,157.19

Service Code	CPT 28299
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,157.19
Rate for Payer: AlohaCare Medicaid	$1,568.64
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$7,085.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$11,157.19

CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH RESECTION OF PROXIMAL PHALANX BASE, WHEN PERFORMED, ANY METHOD

Facility

$7,085.00

Service Code	CPT 28292
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,085.00
Rate for Payer: AlohaCare Medicaid	$901.48
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$7,085.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$5,160.40

CORTEX SCREW, TI, 2.4 X 10MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974372
Hospital Revenue Code	278
Min. Negotiated Rate	$96.50
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$96.50
Rate for Payer: AlohaCare Medicare	$96.50
Rate for Payer: Cash Price	$125.45
Rate for Payer: Devoted Health Medicare	$106.15
Rate for Payer: Hawaii Medical Service Association Medicare	$96.50
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$96.50
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicare	$96.50
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$96.50
Rate for Payer: Ohana Health Plan Medicare	$96.50
Rate for Payer: UnitedHealthcare Medicare	$96.50
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 10MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974372
Hospital Revenue Code	278
Min. Negotiated Rate	$108.08
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$125.45
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 12MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974373
Hospital Revenue Code	278
Min. Negotiated Rate	$96.50
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$96.50
Rate for Payer: AlohaCare Medicare	$96.50
Rate for Payer: Cash Price	$125.45
Rate for Payer: Devoted Health Medicare	$106.15
Rate for Payer: Hawaii Medical Service Association Medicare	$96.50
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$96.50
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicare	$96.50
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$96.50
Rate for Payer: Ohana Health Plan Medicare	$96.50
Rate for Payer: UnitedHealthcare Medicare	$96.50
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 12MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974373
Hospital Revenue Code	278
Min. Negotiated Rate	$108.08
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$125.45
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 16MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974374
Hospital Revenue Code	278
Min. Negotiated Rate	$96.50
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$96.50
Rate for Payer: AlohaCare Medicare	$96.50
Rate for Payer: Cash Price	$125.45
Rate for Payer: Devoted Health Medicare	$106.15
Rate for Payer: Hawaii Medical Service Association Medicare	$96.50
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$96.50
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicare	$96.50
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$96.50
Rate for Payer: Ohana Health Plan Medicare	$96.50
Rate for Payer: UnitedHealthcare Medicare	$96.50
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 16MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974374
Hospital Revenue Code	278
Min. Negotiated Rate	$108.08
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$125.45
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 18MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974366
Hospital Revenue Code	278
Min. Negotiated Rate	$96.50
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$96.50
Rate for Payer: AlohaCare Medicare	$96.50
Rate for Payer: Cash Price	$125.45
Rate for Payer: Devoted Health Medicare	$106.15
Rate for Payer: Hawaii Medical Service Association Medicare	$96.50
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$96.50
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicare	$96.50
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$96.50
Rate for Payer: Ohana Health Plan Medicare	$96.50
Rate for Payer: UnitedHealthcare Medicare	$96.50
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 18MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974366
Hospital Revenue Code	278
Min. Negotiated Rate	$108.08
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$125.45
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 20MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974369
Hospital Revenue Code	278
Min. Negotiated Rate	$96.50
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$96.50
Rate for Payer: AlohaCare Medicare	$96.50
Rate for Payer: Cash Price	$125.45
Rate for Payer: Devoted Health Medicare	$106.15
Rate for Payer: Hawaii Medical Service Association Medicare	$96.50
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$96.50
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicare	$96.50
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$96.50
Rate for Payer: Ohana Health Plan Medicare	$96.50
Rate for Payer: UnitedHealthcare Medicare	$96.50
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 20MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974369
Hospital Revenue Code	278
Min. Negotiated Rate	$108.08
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$125.45
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 22MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974370
Hospital Revenue Code	278
Min. Negotiated Rate	$108.08
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$125.45
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 22MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974370
Hospital Revenue Code	278
Min. Negotiated Rate	$96.50
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$96.50
Rate for Payer: AlohaCare Medicare	$96.50
Rate for Payer: Cash Price	$125.45
Rate for Payer: Devoted Health Medicare	$106.15
Rate for Payer: Hawaii Medical Service Association Medicare	$96.50
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$96.50
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicare	$96.50
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$96.50
Rate for Payer: Ohana Health Plan Medicare	$96.50
Rate for Payer: UnitedHealthcare Medicare	$96.50
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 24MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974367
Hospital Revenue Code	278
Min. Negotiated Rate	$96.50
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$96.50
Rate for Payer: AlohaCare Medicare	$96.50
Rate for Payer: Cash Price	$125.45
Rate for Payer: Devoted Health Medicare	$106.15
Rate for Payer: Hawaii Medical Service Association Medicare	$96.50
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$96.50
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicare	$96.50
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$96.50
Rate for Payer: Ohana Health Plan Medicare	$96.50
Rate for Payer: UnitedHealthcare Medicare	$96.50
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 24MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974367
Hospital Revenue Code	278
Min. Negotiated Rate	$108.08
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$125.45
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 26MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974375
Hospital Revenue Code	278
Min. Negotiated Rate	$96.50
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$96.50
Rate for Payer: AlohaCare Medicare	$96.50
Rate for Payer: Cash Price	$125.45
Rate for Payer: Devoted Health Medicare	$106.15
Rate for Payer: Hawaii Medical Service Association Medicare	$96.50
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$96.50
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicare	$96.50
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$96.50
Rate for Payer: Ohana Health Plan Medicare	$96.50
Rate for Payer: UnitedHealthcare Medicare	$96.50
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 26MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974375
Hospital Revenue Code	278
Min. Negotiated Rate	$108.08
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$125.45
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 28MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974393
Hospital Revenue Code	278
Min. Negotiated Rate	$108.08
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$125.45
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 28MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974393
Hospital Revenue Code	278
Min. Negotiated Rate	$96.50
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$96.50
Rate for Payer: AlohaCare Medicare	$96.50
Rate for Payer: Cash Price	$125.45
Rate for Payer: Devoted Health Medicare	$106.15
Rate for Payer: Hawaii Medical Service Association Medicare	$96.50
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$96.50
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicare	$96.50
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$96.50
Rate for Payer: Ohana Health Plan Medicare	$96.50
Rate for Payer: UnitedHealthcare Medicare	$96.50
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 30MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974394
Hospital Revenue Code	278
Min. Negotiated Rate	$108.08
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$125.45
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 30MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974394
Hospital Revenue Code	278
Min. Negotiated Rate	$96.50
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$96.50
Rate for Payer: AlohaCare Medicare	$96.50
Rate for Payer: Cash Price	$125.45
Rate for Payer: Devoted Health Medicare	$106.15
Rate for Payer: Hawaii Medical Service Association Medicare	$96.50
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$96.50
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicare	$96.50
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$96.50
Rate for Payer: Ohana Health Plan Medicare	$96.50
Rate for Payer: UnitedHealthcare Medicare	$96.50
Rate for Payer: University Health Alliance Commercial	$108.08

CORTEX SCREW, TI, 2.4 X 32MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974395
Hospital Revenue Code	278
Min. Negotiated Rate	$96.50
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$96.50
Rate for Payer: AlohaCare Medicare	$96.50
Rate for Payer: Cash Price	$125.45
Rate for Payer: Devoted Health Medicare	$106.15
Rate for Payer: Hawaii Medical Service Association Medicare	$96.50
Rate for Payer: Hawaii Western Management Group Commercial	$135.10
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$96.50
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicare	$96.50
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$96.50
Rate for Payer: Ohana Health Plan Medicare	$96.50
Rate for Payer: UnitedHealthcare Medicare	$96.50
Rate for Payer: University Health Alliance Commercial	$108.08

Know your out-of-pocket cost for care.

All Charges