Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

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	$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 55MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983661
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 55MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983661
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 60MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983669
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 60MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983669
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 65MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983673
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 65MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983673
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 70MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983670
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 70MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983670
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 75MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983662
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 75MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983662
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 80MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983663
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 80MM

Facility

$145.00

Service Code	HCPCS C1713
Hospital Charge Code	12983663
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 TAP, LARGE HUDSON, 5.0MM

Facility

$1,470.00

Hospital Charge Code	12983764
Hospital Revenue Code	272
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$1,425.90
Rate for Payer: AlohaCare Medicaid	$735.00
Rate for Payer: AlohaCare Medicare	$735.00
Rate for Payer: Cash Price	$955.50
Rate for Payer: Devoted Health Medicare	$808.50
Rate for Payer: Hawaii Medical Service Association Medicare	$735.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,396.50
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: Humana Medicare	$735.00
Rate for Payer: Kaiser Permanente Commercial	$1,323.00
Rate for Payer: Kaiser Permanente Medicaid	$749.70
Rate for Payer: Kaiser Permanente Medicare	$735.00
Rate for Payer: MDX Hawaii PPO	$1,425.90
Rate for Payer: Ohana Health Plan Medicaid	$735.00
Rate for Payer: Ohana Health Plan Medicare	$735.00
Rate for Payer: UnitedHealthcare Medicare	$735.00
Rate for Payer: University Health Alliance Commercial	$1,071.48

CORTICAL TAP, LARGE HUDSON, 5.0MM

Facility

$1,470.00

Hospital Charge Code	12983764
Hospital Revenue Code	272
Min. Negotiated Rate	$1,249.50
Max. Negotiated Rate	$1,425.90
Rate for Payer: Cash Price	$955.50
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: Kaiser Permanente Commercial	$1,323.00
Rate for Payer: MDX Hawaii PPO	$1,425.90

Cortisol, 30 min Post FSI

Facility

$172.00

Service Code	HCPCS 82533
Hospital Charge Code	8117891
Hospital Revenue Code	301
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$166.84
Rate for Payer: AlohaCare Medicaid	$86.00
Rate for Payer: AlohaCare Medicare	$86.00
Rate for Payer: Cash Price	$111.80
Rate for Payer: Cash Price	$111.80
Rate for Payer: Devoted Health Medicare	$94.60
Rate for Payer: Hawaii Medical Service Association ABD	$22.53
Rate for Payer: Hawaii Medical Service Association Commercial	$20.38
Rate for Payer: Hawaii Medical Service Association Medicare	$86.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.66
Rate for Payer: Hawaii Western Management Group Commercial	$16.30
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: Humana Medicare	$86.00
Rate for Payer: Kaiser Permanente Commercial	$154.80
Rate for Payer: Kaiser Permanente Medicaid	$87.72
Rate for Payer: Kaiser Permanente Medicare	$86.00
Rate for Payer: MDX Hawaii PPO	$166.84
Rate for Payer: Ohana Health Plan Medicaid	$86.00
Rate for Payer: Ohana Health Plan Medicare	$86.00
Rate for Payer: UnitedHealthcare Medicaid	$22.53
Rate for Payer: UnitedHealthcare Medicare	$86.00
Rate for Payer: University Health Alliance Commercial	$42.14

Cortisol, 30 min Post FSI

Facility

$172.00

Service Code	HCPCS 82533
Hospital Charge Code	8117891
Hospital Revenue Code	301
Min. Negotiated Rate	$146.20
Max. Negotiated Rate	$166.84
Rate for Payer: Cash Price	$111.80
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: Kaiser Permanente Commercial	$154.80
Rate for Payer: MDX Hawaii PPO	$166.84

Cortisol, 60 min Post FSI

Facility

$172.00

Service Code	HCPCS 82533
Hospital Charge Code	8228861
Hospital Revenue Code	301
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$166.84
Rate for Payer: AlohaCare Medicaid	$86.00
Rate for Payer: AlohaCare Medicare	$86.00
Rate for Payer: Cash Price	$111.80
Rate for Payer: Cash Price	$111.80
Rate for Payer: Devoted Health Medicare	$94.60
Rate for Payer: Hawaii Medical Service Association ABD	$22.53
Rate for Payer: Hawaii Medical Service Association Commercial	$20.38
Rate for Payer: Hawaii Medical Service Association Medicare	$86.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.66
Rate for Payer: Hawaii Western Management Group Commercial	$16.30
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: Humana Medicare	$86.00
Rate for Payer: Kaiser Permanente Commercial	$154.80
Rate for Payer: Kaiser Permanente Medicaid	$87.72
Rate for Payer: Kaiser Permanente Medicare	$86.00
Rate for Payer: MDX Hawaii PPO	$166.84
Rate for Payer: Ohana Health Plan Medicaid	$86.00
Rate for Payer: Ohana Health Plan Medicare	$86.00
Rate for Payer: UnitedHealthcare Medicaid	$22.53
Rate for Payer: UnitedHealthcare Medicare	$86.00
Rate for Payer: University Health Alliance Commercial	$42.14

Cortisol, 60 min Post FSI

Facility

$172.00

Service Code	HCPCS 82533
Hospital Charge Code	8228861
Hospital Revenue Code	301
Min. Negotiated Rate	$146.20
Max. Negotiated Rate	$166.84
Rate for Payer: Cash Price	$111.80
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: Kaiser Permanente Commercial	$154.80
Rate for Payer: MDX Hawaii PPO	$166.84

Cortisol, A.M.

Facility

$128.00

Service Code	HCPCS 82533
Hospital Charge Code	12499892
Hospital Revenue Code	301
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$124.16
Rate for Payer: AlohaCare Medicaid	$64.00
Rate for Payer: AlohaCare Medicare	$64.00
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cash Price	$83.20
Rate for Payer: Devoted Health Medicare	$70.40
Rate for Payer: Hawaii Medical Service Association ABD	$22.53
Rate for Payer: Hawaii Medical Service Association Commercial	$20.38
Rate for Payer: Hawaii Medical Service Association Medicare	$64.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.66
Rate for Payer: Hawaii Western Management Group Commercial	$16.30
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: Humana Medicare	$64.00
Rate for Payer: Kaiser Permanente Commercial	$115.20
Rate for Payer: Kaiser Permanente Medicaid	$65.28
Rate for Payer: Kaiser Permanente Medicare	$64.00
Rate for Payer: MDX Hawaii PPO	$124.16
Rate for Payer: Ohana Health Plan Medicaid	$64.00
Rate for Payer: Ohana Health Plan Medicare	$64.00
Rate for Payer: UnitedHealthcare Medicaid	$22.53
Rate for Payer: UnitedHealthcare Medicare	$64.00
Rate for Payer: University Health Alliance Commercial	$42.14

Cortisol, A.M.

Facility

$128.00

Service Code	HCPCS 82533
Hospital Charge Code	12499892
Hospital Revenue Code	301
Min. Negotiated Rate	$108.80
Max. Negotiated Rate	$124.16
Rate for Payer: Cash Price	$83.20
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: Kaiser Permanente Commercial	$115.20
Rate for Payer: MDX Hawaii PPO	$124.16

Cortisol, Baseline FSI

Facility

$185.00

Service Code	HCPCS 82530
Hospital Charge Code	8117892
Hospital Revenue Code	301
Min. Negotiated Rate	$16.71
Max. Negotiated Rate	$179.45
Rate for Payer: AlohaCare Medicaid	$92.50
Rate for Payer: AlohaCare Medicare	$92.50
Rate for Payer: Cash Price	$120.25
Rate for Payer: Cash Price	$120.25
Rate for Payer: Devoted Health Medicare	$101.75
Rate for Payer: Hawaii Medical Service Association ABD	$23.10
Rate for Payer: Hawaii Medical Service Association Commercial	$20.89
Rate for Payer: Hawaii Medical Service Association Medicare	$92.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.26
Rate for Payer: Hawaii Western Management Group Commercial	$16.71
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Humana Medicare	$92.50
Rate for Payer: Kaiser Permanente Commercial	$166.50
Rate for Payer: Kaiser Permanente Medicaid	$94.35
Rate for Payer: Kaiser Permanente Medicare	$92.50
Rate for Payer: MDX Hawaii PPO	$179.45
Rate for Payer: Ohana Health Plan Medicaid	$92.50
Rate for Payer: Ohana Health Plan Medicare	$92.50
Rate for Payer: UnitedHealthcare Medicaid	$23.10
Rate for Payer: UnitedHealthcare Medicare	$92.50
Rate for Payer: University Health Alliance Commercial	$43.20

Cortisol, Baseline FSI

Facility

$185.00

Service Code	HCPCS 82530
Hospital Charge Code	8117892
Hospital Revenue Code	301
Min. Negotiated Rate	$157.25
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$120.25
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Kaiser Permanente Commercial	$166.50
Rate for Payer: MDX Hawaii PPO	$179.45

Cortisol, Free FSI

Facility

$172.00

Service Code	HCPCS 82533
Hospital Charge Code	8228862
Hospital Revenue Code	301
Min. Negotiated Rate	$146.20
Max. Negotiated Rate	$166.84
Rate for Payer: Cash Price	$111.80
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: Kaiser Permanente Commercial	$154.80
Rate for Payer: MDX Hawaii PPO	$166.84

Cortisol, Free FSI

Facility

$172.00

Service Code	HCPCS 82533
Hospital Charge Code	8228862
Hospital Revenue Code	301
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$166.84
Rate for Payer: AlohaCare Medicaid	$86.00
Rate for Payer: AlohaCare Medicare	$86.00
Rate for Payer: Cash Price	$111.80
Rate for Payer: Cash Price	$111.80
Rate for Payer: Devoted Health Medicare	$94.60
Rate for Payer: Hawaii Medical Service Association ABD	$22.53
Rate for Payer: Hawaii Medical Service Association Commercial	$20.38
Rate for Payer: Hawaii Medical Service Association Medicare	$86.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.66
Rate for Payer: Hawaii Western Management Group Commercial	$16.30
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: Humana Medicare	$86.00
Rate for Payer: Kaiser Permanente Commercial	$154.80
Rate for Payer: Kaiser Permanente Medicaid	$87.72
Rate for Payer: Kaiser Permanente Medicare	$86.00
Rate for Payer: MDX Hawaii PPO	$166.84
Rate for Payer: Ohana Health Plan Medicaid	$86.00
Rate for Payer: Ohana Health Plan Medicare	$86.00
Rate for Payer: UnitedHealthcare Medicaid	$22.53
Rate for Payer: UnitedHealthcare Medicare	$86.00
Rate for Payer: University Health Alliance Commercial	$42.14

Know your out-of-pocket cost for care.

All Charges