Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

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

CORTICAL SCREW, CAPTURED, 5.0 MM X 90 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12975026
Hospital Revenue Code	278
Min. Negotiated Rate	$276.64
Max. Negotiated Rate	$479.18
Rate for Payer: MDX Hawaii PPO	$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: University Health Alliance Commercial	$276.64

CORTICAL SCREW, CAPTURED, 5.0 MM X 90 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12975026
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 95 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12975027
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 95 MM

Facility

$494.00

Service Code	HCPCS C1713
Hospital Charge Code	12975027
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, FT, 6.5X100MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975038
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X100MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975038
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X105MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975028
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X105MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975028
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X110MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975033
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X110MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975033
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X115MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975029
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X115MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975029
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X120MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975030
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X120MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975030
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X30MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975034
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X30MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975034
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X35MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975039
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X35MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975039
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X40MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975043
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X40MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975043
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X45MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975035
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X45MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975035
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X50MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975044
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$669.30
Rate for Payer: AlohaCare Medicaid	$345.00
Rate for Payer: AlohaCare Medicare	$345.00
Rate for Payer: Cash Price	$448.50
Rate for Payer: Devoted Health Medicare	$379.50
Rate for Payer: Hawaii Medical Service Association Medicare	$345.00
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Humana Medicare	$345.00
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: Kaiser Permanente Medicaid	$351.90
Rate for Payer: Kaiser Permanente Medicare	$345.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: Ohana Health Plan Medicaid	$345.00
Rate for Payer: Ohana Health Plan Medicare	$345.00
Rate for Payer: UnitedHealthcare Medicare	$345.00
Rate for Payer: University Health Alliance Commercial	$386.40

CORTICAL SCREW, CAPTURED, FT, 6.5X50MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975044
Hospital Revenue Code	278
Min. Negotiated Rate	$386.40
Max. Negotiated Rate	$669.30
Rate for Payer: Cash Price	$448.50
Rate for Payer: Hawaii Western Management Group Commercial	$483.00
Rate for Payer: Health Management Network Commercial	$586.50
Rate for Payer: Kaiser Permanente Commercial	$621.00
Rate for Payer: MDX Hawaii PPO	$669.30
Rate for Payer: University Health Alliance Commercial	$386.40

Know your out-of-pocket cost for care.

All Charges