Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

CORTICAL SCREW, CAPTURED, FT, 6.5X55MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975040
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, 6.5X55MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975040
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, 6.5X60MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975045
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, 6.5X60MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975045
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, 6.5X65MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975041
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, 6.5X65MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975041
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, 6.5X70MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975042
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, 6.5X70MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12975042
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, 6.5X75MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12983664
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, 6.5X75MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12983664
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, 6.5X80MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12983658
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, 6.5X80MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12983658
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, 6.5X90MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12983665
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, 6.5X90MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12983665
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, 6.5X95MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12983666
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, 6.5X95MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	12983666
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, TI, 2.4 X 42MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983672
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, TI, 2.4 X 42MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983672
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, TI, 2.4 X 44MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983667
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, TI, 2.4 X 44MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983667
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, TI, 2.4 X 46MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983668
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, TI, 2.4 X 46MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983668
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, TI, 2.4 X 48MM

Facility

$232.00

Service Code	HCPCS C1713
Hospital Charge Code	12983659
Hospital Revenue Code	278
Min. Negotiated Rate	$129.92
Max. Negotiated Rate	$225.04
Rate for Payer: Cash Price	$150.80
Rate for Payer: Hawaii Western Management Group Commercial	$162.40
Rate for Payer: Health Management Network Commercial	$197.20
Rate for Payer: Kaiser Permanente Commercial	$208.80
Rate for Payer: MDX Hawaii PPO	$225.04
Rate for Payer: University Health Alliance Commercial	$129.92

CORTICAL SCREW, TI, 2.4 X 48MM

Facility

$232.00

Service Code	HCPCS C1713
Hospital Charge Code	12983659
Hospital Revenue Code	278
Min. Negotiated Rate	$116.00
Max. Negotiated Rate	$225.04
Rate for Payer: AlohaCare Medicaid	$116.00
Rate for Payer: AlohaCare Medicare	$116.00
Rate for Payer: Cash Price	$150.80
Rate for Payer: Devoted Health Medicare	$127.60
Rate for Payer: Hawaii Medical Service Association Medicare	$116.00
Rate for Payer: Hawaii Western Management Group Commercial	$162.40
Rate for Payer: Health Management Network Commercial	$197.20
Rate for Payer: Humana Medicare	$116.00
Rate for Payer: Kaiser Permanente Commercial	$208.80
Rate for Payer: Kaiser Permanente Medicaid	$118.32
Rate for Payer: Kaiser Permanente Medicare	$116.00
Rate for Payer: MDX Hawaii PPO	$225.04
Rate for Payer: Ohana Health Plan Medicaid	$116.00
Rate for Payer: Ohana Health Plan Medicare	$116.00
Rate for Payer: UnitedHealthcare Medicare	$116.00
Rate for Payer: University Health Alliance Commercial	$129.92

CORTICAL SCREW, TI, 2.4 X 50MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983660
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

Know your out-of-pocket cost for care.

All Charges