Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

CORTICAL SCREW, CAPTURED, 5.0 MM X 32 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985442
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 32 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985442
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 34 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985431
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 34 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985431
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 36 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985436
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 36 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985436
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 38 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985443
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 38 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985443
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 40 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985432
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 40 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985432
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 42 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985437
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 42 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985437
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 44 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985438
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 44 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985438
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 46 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985444
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 46 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985444
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 48 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985433
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 48 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985433
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 50 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985434
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 50 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985434
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 55 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985435
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 55 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985435
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 60 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985439
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 60 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12985439
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 85 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12975025
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

Know your out-of-pocket cost for care.

All Charges