Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

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

CORTEX SCREW, TI, 2.4 X 34MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974396
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 34MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974396
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 8MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974397
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 8MM

Facility

$193.00

Service Code	HCPCS C1713
Hospital Charge Code	12974397
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

CORTICAL LPS SCREW, TI, 3.5X 13MM

Facility

$126.00

Service Code	HCPCS C1713
Hospital Charge Code	12974399
Hospital Revenue Code	278
Min. Negotiated Rate	$70.56
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$81.90
Rate for Payer: Hawaii Western Management Group Commercial	$88.20
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: University Health Alliance Commercial	$70.56

CORTICAL LPS SCREW, TI, 3.5X 13MM

Facility

$126.00

Service Code	HCPCS C1713
Hospital Charge Code	12974399
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$122.22
Rate for Payer: AlohaCare Medicaid	$63.00
Rate for Payer: AlohaCare Medicare	$63.00
Rate for Payer: Cash Price	$81.90
Rate for Payer: Devoted Health Medicare	$69.30
Rate for Payer: Hawaii Medical Service Association Medicare	$63.00
Rate for Payer: Hawaii Western Management Group Commercial	$88.20
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Humana Medicare	$63.00
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$63.00
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$63.00
Rate for Payer: Ohana Health Plan Medicare	$63.00
Rate for Payer: UnitedHealthcare Medicare	$63.00
Rate for Payer: University Health Alliance Commercial	$70.56

CORTICAL SCREW, 2.4 MM X 6 MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12974402
Hospital Revenue Code	278
Min. Negotiated Rate	$81.20
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$94.25
Rate for Payer: Hawaii Western Management Group Commercial	$101.50
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: University Health Alliance Commercial	$81.20

CORTICAL SCREW, 2.4 MM X 6 MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12974402
Hospital Revenue Code	278
Min. Negotiated Rate	$72.50
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$72.50
Rate for Payer: AlohaCare Medicare	$72.50
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$79.75
Rate for Payer: Hawaii Medical Service Association Medicare	$72.50
Rate for Payer: Hawaii Western Management Group Commercial	$101.50
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$72.50
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$72.50
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$72.50
Rate for Payer: Ohana Health Plan Medicare	$72.50
Rate for Payer: UnitedHealthcare Medicare	$72.50
Rate for Payer: University Health Alliance Commercial	$81.20

CORTICAL SCREW, 2.4 MM X 7 MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12974406
Hospital Revenue Code	278
Min. Negotiated Rate	$81.20
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$94.25
Rate for Payer: Hawaii Western Management Group Commercial	$101.50
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: University Health Alliance Commercial	$81.20

CORTICAL SCREW, 2.4 MM X 7 MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12974406
Hospital Revenue Code	278
Min. Negotiated Rate	$72.50
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$72.50
Rate for Payer: AlohaCare Medicare	$72.50
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$79.75
Rate for Payer: Hawaii Medical Service Association Medicare	$72.50
Rate for Payer: Hawaii Western Management Group Commercial	$101.50
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$72.50
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$72.50
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$72.50
Rate for Payer: Ohana Health Plan Medicare	$72.50
Rate for Payer: UnitedHealthcare Medicare	$72.50
Rate for Payer: University Health Alliance Commercial	$81.20

CORTICAL SCREW, 2.7 MM X 10 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974403
Hospital Revenue Code	278
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$153.26
Rate for Payer: AlohaCare Medicaid	$79.00
Rate for Payer: AlohaCare Medicare	$79.00
Rate for Payer: Cash Price	$102.70
Rate for Payer: Devoted Health Medicare	$86.90
Rate for Payer: Hawaii Medical Service Association Medicare	$79.00
Rate for Payer: Hawaii Western Management Group Commercial	$110.60
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Humana Medicare	$79.00
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: Kaiser Permanente Medicaid	$80.58
Rate for Payer: Kaiser Permanente Medicare	$79.00
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: Ohana Health Plan Medicaid	$79.00
Rate for Payer: Ohana Health Plan Medicare	$79.00
Rate for Payer: UnitedHealthcare Medicare	$79.00
Rate for Payer: University Health Alliance Commercial	$88.48

CORTICAL SCREW, 2.7 MM X 10 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974403
Hospital Revenue Code	278
Min. Negotiated Rate	$88.48
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$102.70
Rate for Payer: Hawaii Western Management Group Commercial	$110.60
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: University Health Alliance Commercial	$88.48

CORTICAL SCREW, 2.7 MM X 11 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974407
Hospital Revenue Code	278
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$153.26
Rate for Payer: AlohaCare Medicaid	$79.00
Rate for Payer: AlohaCare Medicare	$79.00
Rate for Payer: Cash Price	$102.70
Rate for Payer: Devoted Health Medicare	$86.90
Rate for Payer: Hawaii Medical Service Association Medicare	$79.00
Rate for Payer: Hawaii Western Management Group Commercial	$110.60
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Humana Medicare	$79.00
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: Kaiser Permanente Medicaid	$80.58
Rate for Payer: Kaiser Permanente Medicare	$79.00
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: Ohana Health Plan Medicaid	$79.00
Rate for Payer: Ohana Health Plan Medicare	$79.00
Rate for Payer: UnitedHealthcare Medicare	$79.00
Rate for Payer: University Health Alliance Commercial	$88.48

CORTICAL SCREW, 2.7 MM X 11 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974407
Hospital Revenue Code	278
Min. Negotiated Rate	$88.48
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$102.70
Rate for Payer: Hawaii Western Management Group Commercial	$110.60
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: University Health Alliance Commercial	$88.48

CORTICAL SCREW, 2.7 MM X 12 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974404
Hospital Revenue Code	278
Min. Negotiated Rate	$88.48
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$102.70
Rate for Payer: Hawaii Western Management Group Commercial	$110.60
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: University Health Alliance Commercial	$88.48

CORTICAL SCREW, 2.7 MM X 12 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974404
Hospital Revenue Code	278
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$153.26
Rate for Payer: AlohaCare Medicaid	$79.00
Rate for Payer: AlohaCare Medicare	$79.00
Rate for Payer: Cash Price	$102.70
Rate for Payer: Devoted Health Medicare	$86.90
Rate for Payer: Hawaii Medical Service Association Medicare	$79.00
Rate for Payer: Hawaii Western Management Group Commercial	$110.60
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Humana Medicare	$79.00
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: Kaiser Permanente Medicaid	$80.58
Rate for Payer: Kaiser Permanente Medicare	$79.00
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: Ohana Health Plan Medicaid	$79.00
Rate for Payer: Ohana Health Plan Medicare	$79.00
Rate for Payer: UnitedHealthcare Medicare	$79.00
Rate for Payer: University Health Alliance Commercial	$88.48

CORTICAL SCREW, 2.7 MM X 13 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974400
Hospital Revenue Code	278
Min. Negotiated Rate	$88.48
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$102.70
Rate for Payer: Hawaii Western Management Group Commercial	$110.60
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: University Health Alliance Commercial	$88.48

CORTICAL SCREW, 2.7 MM X 13 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974400
Hospital Revenue Code	278
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$153.26
Rate for Payer: AlohaCare Medicaid	$79.00
Rate for Payer: AlohaCare Medicare	$79.00
Rate for Payer: Cash Price	$102.70
Rate for Payer: Devoted Health Medicare	$86.90
Rate for Payer: Hawaii Medical Service Association Medicare	$79.00
Rate for Payer: Hawaii Western Management Group Commercial	$110.60
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Humana Medicare	$79.00
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: Kaiser Permanente Medicaid	$80.58
Rate for Payer: Kaiser Permanente Medicare	$79.00
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: Ohana Health Plan Medicaid	$79.00
Rate for Payer: Ohana Health Plan Medicare	$79.00
Rate for Payer: UnitedHealthcare Medicare	$79.00
Rate for Payer: University Health Alliance Commercial	$88.48

CORTICAL SCREW, 2.7 MM X 14 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974408
Hospital Revenue Code	278
Min. Negotiated Rate	$88.48
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$102.70
Rate for Payer: Hawaii Western Management Group Commercial	$110.60
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: University Health Alliance Commercial	$88.48

CORTICAL SCREW, 2.7 MM X 14 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974408
Hospital Revenue Code	278
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$153.26
Rate for Payer: AlohaCare Medicaid	$79.00
Rate for Payer: AlohaCare Medicare	$79.00
Rate for Payer: Cash Price	$102.70
Rate for Payer: Devoted Health Medicare	$86.90
Rate for Payer: Hawaii Medical Service Association Medicare	$79.00
Rate for Payer: Hawaii Western Management Group Commercial	$110.60
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Humana Medicare	$79.00
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: Kaiser Permanente Medicaid	$80.58
Rate for Payer: Kaiser Permanente Medicare	$79.00
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: Ohana Health Plan Medicaid	$79.00
Rate for Payer: Ohana Health Plan Medicare	$79.00
Rate for Payer: UnitedHealthcare Medicare	$79.00
Rate for Payer: University Health Alliance Commercial	$88.48

CORTICAL SCREW, 2.7 MM X 15 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974409
Hospital Revenue Code	278
Min. Negotiated Rate	$88.48
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$102.70
Rate for Payer: Hawaii Western Management Group Commercial	$110.60
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: University Health Alliance Commercial	$88.48

CORTICAL SCREW, 2.7 MM X 15 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974409
Hospital Revenue Code	278
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$153.26
Rate for Payer: AlohaCare Medicaid	$79.00
Rate for Payer: AlohaCare Medicare	$79.00
Rate for Payer: Cash Price	$102.70
Rate for Payer: Devoted Health Medicare	$86.90
Rate for Payer: Hawaii Medical Service Association Medicare	$79.00
Rate for Payer: Hawaii Western Management Group Commercial	$110.60
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Humana Medicare	$79.00
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: Kaiser Permanente Medicaid	$80.58
Rate for Payer: Kaiser Permanente Medicare	$79.00
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: Ohana Health Plan Medicaid	$79.00
Rate for Payer: Ohana Health Plan Medicare	$79.00
Rate for Payer: UnitedHealthcare Medicare	$79.00
Rate for Payer: University Health Alliance Commercial	$88.48

CORTICAL SCREW, 2.7 MM X 16 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974405
Hospital Revenue Code	278
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$153.26
Rate for Payer: AlohaCare Medicaid	$79.00
Rate for Payer: AlohaCare Medicare	$79.00
Rate for Payer: Cash Price	$102.70
Rate for Payer: Devoted Health Medicare	$86.90
Rate for Payer: Hawaii Medical Service Association Medicare	$79.00
Rate for Payer: Hawaii Western Management Group Commercial	$110.60
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Humana Medicare	$79.00
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: Kaiser Permanente Medicaid	$80.58
Rate for Payer: Kaiser Permanente Medicare	$79.00
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: Ohana Health Plan Medicaid	$79.00
Rate for Payer: Ohana Health Plan Medicare	$79.00
Rate for Payer: UnitedHealthcare Medicare	$79.00
Rate for Payer: University Health Alliance Commercial	$88.48

CORTICAL SCREW, 2.7 MM X 16 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974405
Hospital Revenue Code	278
Min. Negotiated Rate	$88.48
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$102.70
Rate for Payer: Hawaii Western Management Group Commercial	$110.60
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: University Health Alliance Commercial	$88.48

Know your out-of-pocket cost for care.

All Charges