Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

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	$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 65 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974655
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 65 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974655
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 70 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974648
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 70 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974648
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 75 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974653
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 75 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974653
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 7 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974652
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 7 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974652
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 80 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974654
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 80 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974654
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 8 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974656
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 8 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974656
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 9 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974657
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 9 MM

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	12974657
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, CAPTURED, 5.0MM X 100MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12975032
Hospital Revenue Code	278
Min. Negotiated Rate	$247.00
Max. Negotiated Rate	$479.18
Rate for Payer: AlohaCare Medicaid	$247.00
Rate for Payer: AlohaCare Medicare	$247.00
Rate for Payer: Cash Price	$321.10
Rate for Payer: Devoted Health Medicare	$271.70
Rate for Payer: Hawaii Medical Service Association Medicare	$247.00
Rate for Payer: Hawaii Western Management Group Commercial	$345.80
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: Humana Medicare	$247.00
Rate for Payer: Kaiser Permanente Commercial	$444.60
Rate for Payer: Kaiser Permanente Medicaid	$251.94
Rate for Payer: Kaiser Permanente Medicare	$247.00
Rate for Payer: MDX Hawaii PPO	$479.18
Rate for Payer: Ohana Health Plan Medicaid	$247.00
Rate for Payer: Ohana Health Plan Medicare	$247.00
Rate for Payer: UnitedHealthcare Medicare	$247.00
Rate for Payer: University Health Alliance Commercial	$276.64

CORTICAL SCREW, CAPTURED, 5.0MM X 100MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12975032
Hospital Revenue Code	278
Min. Negotiated Rate	$276.64
Max. Negotiated Rate	$479.18
Rate for Payer: Cash Price	$321.10
Rate for Payer: Hawaii Western Management Group Commercial	$345.80
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: Kaiser Permanente Commercial	$444.60
Rate for Payer: MDX Hawaii PPO	$479.18
Rate for Payer: University Health Alliance Commercial	$276.64

CORTICAL SCREW, CAPTURED, 5.0 MM X 24 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985429
Hospital Revenue Code	278
Min. Negotiated Rate	$247.00
Max. Negotiated Rate	$479.18
Rate for Payer: AlohaCare Medicaid	$247.00
Rate for Payer: AlohaCare Medicare	$247.00
Rate for Payer: Cash Price	$321.10
Rate for Payer: Devoted Health Medicare	$271.70
Rate for Payer: Hawaii Medical Service Association Medicare	$247.00
Rate for Payer: Hawaii Western Management Group Commercial	$345.80
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: Humana Medicare	$247.00
Rate for Payer: Kaiser Permanente Commercial	$444.60
Rate for Payer: Kaiser Permanente Medicaid	$251.94
Rate for Payer: Kaiser Permanente Medicare	$247.00
Rate for Payer: MDX Hawaii PPO	$479.18
Rate for Payer: Ohana Health Plan Medicaid	$247.00
Rate for Payer: Ohana Health Plan Medicare	$247.00
Rate for Payer: UnitedHealthcare Medicare	$247.00
Rate for Payer: University Health Alliance Commercial	$276.64

CORTICAL SCREW, CAPTURED, 5.0 MM X 24 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985429
Hospital Revenue Code	278
Min. Negotiated Rate	$276.64
Max. Negotiated Rate	$479.18
Rate for Payer: Cash Price	$321.10
Rate for Payer: Hawaii Western Management Group Commercial	$345.80
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: Kaiser Permanente Commercial	$444.60
Rate for Payer: MDX Hawaii PPO	$479.18
Rate for Payer: University Health Alliance Commercial	$276.64

CORTICAL SCREW, CAPTURED, 5.0 MM X 26 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985440
Hospital Revenue Code	278
Min. Negotiated Rate	$276.64
Max. Negotiated Rate	$479.18
Rate for Payer: Cash Price	$321.10
Rate for Payer: Hawaii Western Management Group Commercial	$345.80
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: Kaiser Permanente Commercial	$444.60
Rate for Payer: MDX Hawaii PPO	$479.18
Rate for Payer: University Health Alliance Commercial	$276.64

CORTICAL SCREW, CAPTURED, 5.0 MM X 26 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985440
Hospital Revenue Code	278
Min. Negotiated Rate	$247.00
Max. Negotiated Rate	$479.18
Rate for Payer: AlohaCare Medicaid	$247.00
Rate for Payer: AlohaCare Medicare	$247.00
Rate for Payer: Cash Price	$321.10
Rate for Payer: Devoted Health Medicare	$271.70
Rate for Payer: Hawaii Medical Service Association Medicare	$247.00
Rate for Payer: Hawaii Western Management Group Commercial	$345.80
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: Humana Medicare	$247.00
Rate for Payer: Kaiser Permanente Commercial	$444.60
Rate for Payer: Kaiser Permanente Medicaid	$251.94
Rate for Payer: Kaiser Permanente Medicare	$247.00
Rate for Payer: MDX Hawaii PPO	$479.18
Rate for Payer: Ohana Health Plan Medicaid	$247.00
Rate for Payer: Ohana Health Plan Medicare	$247.00
Rate for Payer: UnitedHealthcare Medicare	$247.00
Rate for Payer: University Health Alliance Commercial	$276.64

CORTICAL SCREW, CAPTURED, 5.0 MM X 28 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985430
Hospital Revenue Code	278
Min. Negotiated Rate	$276.64
Max. Negotiated Rate	$479.18
Rate for Payer: Cash Price	$321.10
Rate for Payer: Hawaii Western Management Group Commercial	$345.80
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: Kaiser Permanente Commercial	$444.60
Rate for Payer: MDX Hawaii PPO	$479.18
Rate for Payer: University Health Alliance Commercial	$276.64

CORTICAL SCREW, CAPTURED, 5.0 MM X 28 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985430
Hospital Revenue Code	278
Min. Negotiated Rate	$247.00
Max. Negotiated Rate	$479.18
Rate for Payer: AlohaCare Medicaid	$247.00
Rate for Payer: AlohaCare Medicare	$247.00
Rate for Payer: Cash Price	$321.10
Rate for Payer: Devoted Health Medicare	$271.70
Rate for Payer: Hawaii Medical Service Association Medicare	$247.00
Rate for Payer: Hawaii Western Management Group Commercial	$345.80
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: Humana Medicare	$247.00
Rate for Payer: Kaiser Permanente Commercial	$444.60
Rate for Payer: Kaiser Permanente Medicaid	$251.94
Rate for Payer: Kaiser Permanente Medicare	$247.00
Rate for Payer: MDX Hawaii PPO	$479.18
Rate for Payer: Ohana Health Plan Medicaid	$247.00
Rate for Payer: Ohana Health Plan Medicare	$247.00
Rate for Payer: UnitedHealthcare Medicare	$247.00
Rate for Payer: University Health Alliance Commercial	$276.64

CORTICAL SCREW, CAPTURED, 5.0 MM X 30 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985441
Hospital Revenue Code	278
Min. Negotiated Rate	$247.00
Max. Negotiated Rate	$479.18
Rate for Payer: AlohaCare Medicaid	$247.00
Rate for Payer: AlohaCare Medicare	$247.00
Rate for Payer: Cash Price	$321.10
Rate for Payer: Devoted Health Medicare	$271.70
Rate for Payer: Hawaii Medical Service Association Medicare	$247.00
Rate for Payer: Hawaii Western Management Group Commercial	$345.80
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: Humana Medicare	$247.00
Rate for Payer: Kaiser Permanente Commercial	$444.60
Rate for Payer: Kaiser Permanente Medicaid	$251.94
Rate for Payer: Kaiser Permanente Medicare	$247.00
Rate for Payer: MDX Hawaii PPO	$479.18
Rate for Payer: Ohana Health Plan Medicaid	$247.00
Rate for Payer: Ohana Health Plan Medicare	$247.00
Rate for Payer: UnitedHealthcare Medicare	$247.00
Rate for Payer: University Health Alliance Commercial	$276.64

CORTICAL SCREW, CAPTURED, 5.0 MM X 30 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985441
Hospital Revenue Code	278
Min. Negotiated Rate	$276.64
Max. Negotiated Rate	$479.18
Rate for Payer: Cash Price	$321.10
Rate for Payer: Hawaii Western Management Group Commercial	$345.80
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: Kaiser Permanente Commercial	$444.60
Rate for Payer: MDX Hawaii PPO	$479.18
Rate for Payer: University Health Alliance Commercial	$276.64

Know your out-of-pocket cost for care.

All Charges