Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

CORTICAL SCREW, 2.7 MM X 22 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974545
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 22 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974545
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 24 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12985326
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 24 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12985326
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 26 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12985327
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 26 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12985327
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 28 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12985325
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 28 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12985325
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 30 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12985329
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 30 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12985329
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 34 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12985330
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 34 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12985330
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 36 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12985332
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 36 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12985332
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 38 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12985333
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 38 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12985333
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 42 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12983516
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 42 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12983516
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 44 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12983518
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 44 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12983518
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 46 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12983519
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 46 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12983519
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 48 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12983517
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 48 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12983517
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 60 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974650
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