Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

ORTHO FAST FIX 360 CURVED NEEDLE

Facility

$1,630.00

Hospital Charge Code	8336062
Hospital Revenue Code	272
Min. Negotiated Rate	$815.00
Max. Negotiated Rate	$1,581.10
Rate for Payer: AlohaCare Medicaid	$815.00
Rate for Payer: AlohaCare Medicare	$815.00
Rate for Payer: Cash Price	$1,059.50
Rate for Payer: Devoted Health Medicare	$896.50
Rate for Payer: Hawaii Medical Service Association Medicare	$815.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,548.50
Rate for Payer: Health Management Network Commercial	$1,385.50
Rate for Payer: Humana Medicare	$815.00
Rate for Payer: Kaiser Permanente Commercial	$1,467.00
Rate for Payer: Kaiser Permanente Medicaid	$831.30
Rate for Payer: Kaiser Permanente Medicare	$815.00
Rate for Payer: MDX Hawaii PPO	$1,581.10
Rate for Payer: Ohana Health Plan Medicaid	$815.00
Rate for Payer: Ohana Health Plan Medicare	$815.00
Rate for Payer: UnitedHealthcare Medicare	$815.00
Rate for Payer: University Health Alliance Commercial	$1,188.11

ORTHO, FAST FIX 360 KPSC & SLOTTED CANNULA

Facility

$560.00

Service Code	HCPCS C1713
Hospital Charge Code	8336063
Hospital Revenue Code	272
Min. Negotiated Rate	$476.00
Max. Negotiated Rate	$543.20
Rate for Payer: Cash Price	$364.00
Rate for Payer: Health Management Network Commercial	$476.00
Rate for Payer: Kaiser Permanente Commercial	$504.00
Rate for Payer: MDX Hawaii PPO	$543.20

ORTHO, FAST FIX 360 KPSC & SLOTTED CANNULA

Facility

$560.00

Service Code	HCPCS C1713
Hospital Charge Code	8336063
Hospital Revenue Code	272
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$543.20
Rate for Payer: AlohaCare Medicaid	$280.00
Rate for Payer: AlohaCare Medicare	$280.00
Rate for Payer: Cash Price	$364.00
Rate for Payer: Devoted Health Medicare	$308.00
Rate for Payer: Hawaii Medical Service Association Medicare	$280.00
Rate for Payer: Hawaii Western Management Group Commercial	$532.00
Rate for Payer: Health Management Network Commercial	$476.00
Rate for Payer: Humana Medicare	$280.00
Rate for Payer: Kaiser Permanente Commercial	$504.00
Rate for Payer: Kaiser Permanente Medicaid	$285.60
Rate for Payer: Kaiser Permanente Medicare	$280.00
Rate for Payer: MDX Hawaii PPO	$543.20
Rate for Payer: Ohana Health Plan Medicaid	$280.00
Rate for Payer: Ohana Health Plan Medicare	$280.00
Rate for Payer: UnitedHealthcare Medicare	$280.00
Rate for Payer: University Health Alliance Commercial	$408.18

ORTHO:FIBERTAPE 17W/STR NDL

Facility

$769.00

Service Code	HCPCS C1713
Hospital Charge Code	13241686
Hospital Revenue Code	278
Min. Negotiated Rate	$384.50
Max. Negotiated Rate	$745.93
Rate for Payer: AlohaCare Medicaid	$384.50
Rate for Payer: AlohaCare Medicare	$384.50
Rate for Payer: Cash Price	$499.85
Rate for Payer: Devoted Health Medicare	$422.95
Rate for Payer: Hawaii Medical Service Association Medicare	$384.50
Rate for Payer: Hawaii Western Management Group Commercial	$538.30
Rate for Payer: Health Management Network Commercial	$653.65
Rate for Payer: Humana Medicare	$384.50
Rate for Payer: Kaiser Permanente Commercial	$692.10
Rate for Payer: Kaiser Permanente Medicaid	$392.19
Rate for Payer: Kaiser Permanente Medicare	$384.50
Rate for Payer: MDX Hawaii PPO	$745.93
Rate for Payer: Ohana Health Plan Medicaid	$384.50
Rate for Payer: Ohana Health Plan Medicare	$384.50
Rate for Payer: UnitedHealthcare Medicare	$384.50
Rate for Payer: University Health Alliance Commercial	$430.64

ORTHO:FIBERTAPE 17W/STR NDL

Facility

$769.00

Service Code	HCPCS C1713
Hospital Charge Code	13241686
Hospital Revenue Code	278
Min. Negotiated Rate	$430.64
Max. Negotiated Rate	$745.93
Rate for Payer: Cash Price	$499.85
Rate for Payer: Hawaii Western Management Group Commercial	$538.30
Rate for Payer: Health Management Network Commercial	$653.65
Rate for Payer: Kaiser Permanente Commercial	$692.10
Rate for Payer: MDX Hawaii PPO	$745.93
Rate for Payer: University Health Alliance Commercial	$430.64

ORTHO FIBULINK SYNDESMOSIS REPAIR KIT/SS

Facility

$5,120.00

Hospital Charge Code	9523108
Hospital Revenue Code	272
Min. Negotiated Rate	$2,560.00
Max. Negotiated Rate	$4,966.40
Rate for Payer: AlohaCare Medicaid	$2,560.00
Rate for Payer: AlohaCare Medicare	$2,560.00
Rate for Payer: Cash Price	$3,328.00
Rate for Payer: Devoted Health Medicare	$2,816.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,864.00
Rate for Payer: Health Management Network Commercial	$4,352.00
Rate for Payer: Humana Medicare	$2,560.00
Rate for Payer: Kaiser Permanente Commercial	$4,608.00
Rate for Payer: Kaiser Permanente Medicaid	$2,611.20
Rate for Payer: Kaiser Permanente Medicare	$2,560.00
Rate for Payer: MDX Hawaii PPO	$4,966.40
Rate for Payer: Ohana Health Plan Medicaid	$2,560.00
Rate for Payer: Ohana Health Plan Medicare	$2,560.00
Rate for Payer: UnitedHealthcare Medicare	$2,560.00
Rate for Payer: University Health Alliance Commercial	$3,731.97

ORTHO FIBULINK SYNDESMOSIS REPAIR KIT/SS

Facility

$5,120.00

Hospital Charge Code	9523108
Hospital Revenue Code	272
Min. Negotiated Rate	$4,352.00
Max. Negotiated Rate	$4,966.40
Rate for Payer: Cash Price	$3,328.00
Rate for Payer: Health Management Network Commercial	$4,352.00
Rate for Payer: Kaiser Permanente Commercial	$4,608.00
Rate for Payer: MDX Hawaii PPO	$4,966.40

ORTHO GUIDE WIRE 1.25MM THREAD 150MM

Facility

$240.00

Service Code	HCPCS C1769
Hospital Charge Code	9134124
Hospital Revenue Code	272
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$232.80
Rate for Payer: AlohaCare Medicaid	$120.00
Rate for Payer: AlohaCare Medicare	$120.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Devoted Health Medicare	$132.00
Rate for Payer: Hawaii Medical Service Association Medicare	$120.00
Rate for Payer: Hawaii Western Management Group Commercial	$228.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Humana Medicare	$120.00
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: Kaiser Permanente Medicaid	$122.40
Rate for Payer: Kaiser Permanente Medicare	$120.00
Rate for Payer: MDX Hawaii PPO	$232.80
Rate for Payer: Ohana Health Plan Medicaid	$120.00
Rate for Payer: Ohana Health Plan Medicare	$120.00
Rate for Payer: UnitedHealthcare Medicare	$120.00
Rate for Payer: University Health Alliance Commercial	$174.94

ORTHO GUIDE WIRE 1.25MM THREAD 150MM

Facility

$240.00

Service Code	HCPCS C1769
Hospital Charge Code	9134124
Hospital Revenue Code	272
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$156.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: MDX Hawaii PPO	$232.80

ORTHO ICG SPY-MIS PACK

Facility

$749.00

Hospital Charge Code	8847877
Hospital Revenue Code	272
Min. Negotiated Rate	$374.50
Max. Negotiated Rate	$726.53
Rate for Payer: AlohaCare Medicaid	$374.50
Rate for Payer: AlohaCare Medicare	$374.50
Rate for Payer: Cash Price	$486.85
Rate for Payer: Devoted Health Medicare	$411.95
Rate for Payer: Hawaii Medical Service Association Medicare	$374.50
Rate for Payer: Hawaii Western Management Group Commercial	$711.55
Rate for Payer: Health Management Network Commercial	$636.65
Rate for Payer: Humana Medicare	$374.50
Rate for Payer: Kaiser Permanente Commercial	$674.10
Rate for Payer: Kaiser Permanente Medicaid	$381.99
Rate for Payer: Kaiser Permanente Medicare	$374.50
Rate for Payer: MDX Hawaii PPO	$726.53
Rate for Payer: Ohana Health Plan Medicaid	$374.50
Rate for Payer: Ohana Health Plan Medicare	$374.50
Rate for Payer: UnitedHealthcare Medicare	$374.50
Rate for Payer: University Health Alliance Commercial	$545.95

ORTHO ICG SPY-MIS PACK

Facility

$749.00

Hospital Charge Code	8847877
Hospital Revenue Code	272
Min. Negotiated Rate	$636.65
Max. Negotiated Rate	$726.53
Rate for Payer: Cash Price	$486.85
Rate for Payer: Health Management Network Commercial	$636.65
Rate for Payer: Kaiser Permanente Commercial	$674.10
Rate for Payer: MDX Hawaii PPO	$726.53

ORTHO, KNIFE RETROGRADE LIGAMENT

Facility

$1,225.00

Hospital Charge Code	8584547
Hospital Revenue Code	272
Min. Negotiated Rate	$1,041.25
Max. Negotiated Rate	$1,188.25
Rate for Payer: Cash Price	$796.25
Rate for Payer: Health Management Network Commercial	$1,041.25
Rate for Payer: Kaiser Permanente Commercial	$1,102.50
Rate for Payer: MDX Hawaii PPO	$1,188.25

ORTHO, KNIFE RETROGRADE LIGAMENT

Facility

$1,225.00

Hospital Charge Code	8584547
Hospital Revenue Code	272
Min. Negotiated Rate	$612.50
Max. Negotiated Rate	$1,188.25
Rate for Payer: AlohaCare Medicaid	$612.50
Rate for Payer: AlohaCare Medicare	$612.50
Rate for Payer: Cash Price	$796.25
Rate for Payer: Devoted Health Medicare	$673.75
Rate for Payer: Hawaii Medical Service Association Medicare	$612.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,163.75
Rate for Payer: Health Management Network Commercial	$1,041.25
Rate for Payer: Humana Medicare	$612.50
Rate for Payer: Kaiser Permanente Commercial	$1,102.50
Rate for Payer: Kaiser Permanente Medicaid	$624.75
Rate for Payer: Kaiser Permanente Medicare	$612.50
Rate for Payer: MDX Hawaii PPO	$1,188.25
Rate for Payer: Ohana Health Plan Medicaid	$612.50
Rate for Payer: Ohana Health Plan Medicare	$612.50
Rate for Payer: UnitedHealthcare Medicare	$612.50
Rate for Payer: University Health Alliance Commercial	$892.90

ORTHO KNOTLESS S MULTIFIX 5.5MM

Facility

$2,525.00

Hospital Charge Code	8336038
Hospital Revenue Code	272
Min. Negotiated Rate	$1,262.50
Max. Negotiated Rate	$2,449.25
Rate for Payer: AlohaCare Medicaid	$1,262.50
Rate for Payer: AlohaCare Medicare	$1,262.50
Rate for Payer: Cash Price	$1,641.25
Rate for Payer: Devoted Health Medicare	$1,388.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,262.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,398.75
Rate for Payer: Health Management Network Commercial	$2,146.25
Rate for Payer: Humana Medicare	$1,262.50
Rate for Payer: Kaiser Permanente Commercial	$2,272.50
Rate for Payer: Kaiser Permanente Medicaid	$1,287.75
Rate for Payer: Kaiser Permanente Medicare	$1,262.50
Rate for Payer: MDX Hawaii PPO	$2,449.25
Rate for Payer: Ohana Health Plan Medicaid	$1,262.50
Rate for Payer: Ohana Health Plan Medicare	$1,262.50
Rate for Payer: UnitedHealthcare Medicare	$1,262.50
Rate for Payer: University Health Alliance Commercial	$1,840.47

ORTHO KNOTLESS S MULTIFIX 5.5MM

Facility

$2,525.00

Hospital Charge Code	8336038
Hospital Revenue Code	272
Min. Negotiated Rate	$2,146.25
Max. Negotiated Rate	$2,449.25
Rate for Payer: Cash Price	$1,641.25
Rate for Payer: Health Management Network Commercial	$2,146.25
Rate for Payer: Kaiser Permanente Commercial	$2,272.50
Rate for Payer: MDX Hawaii PPO	$2,449.25

ORTHO KNOTLESS S MULTIFIX 6.5 MM

Facility

$2,525.00

Hospital Charge Code	8336039
Hospital Revenue Code	272
Min. Negotiated Rate	$2,146.25
Max. Negotiated Rate	$2,449.25
Rate for Payer: Cash Price	$1,641.25
Rate for Payer: Health Management Network Commercial	$2,146.25
Rate for Payer: Kaiser Permanente Commercial	$2,272.50
Rate for Payer: MDX Hawaii PPO	$2,449.25

ORTHO KNOTLESS S MULTIFIX 6.5 MM

Facility

$2,525.00

Hospital Charge Code	8336039
Hospital Revenue Code	272
Min. Negotiated Rate	$1,262.50
Max. Negotiated Rate	$2,449.25
Rate for Payer: AlohaCare Medicaid	$1,262.50
Rate for Payer: AlohaCare Medicare	$1,262.50
Rate for Payer: Cash Price	$1,641.25
Rate for Payer: Devoted Health Medicare	$1,388.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,262.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,398.75
Rate for Payer: Health Management Network Commercial	$2,146.25
Rate for Payer: Humana Medicare	$1,262.50
Rate for Payer: Kaiser Permanente Commercial	$2,272.50
Rate for Payer: Kaiser Permanente Medicaid	$1,287.75
Rate for Payer: Kaiser Permanente Medicare	$1,262.50
Rate for Payer: MDX Hawaii PPO	$2,449.25
Rate for Payer: Ohana Health Plan Medicaid	$1,262.50
Rate for Payer: Ohana Health Plan Medicare	$1,262.50
Rate for Payer: UnitedHealthcare Medicare	$1,262.50
Rate for Payer: University Health Alliance Commercial	$1,840.47

ORTHO: LCP ONE-THIRD TUBULAR PLATE 10 HOLE

Facility

$1,281.00

Service Code	HCPCS C1713
Hospital Charge Code	9595027
Hospital Revenue Code	278
Min. Negotiated Rate	$640.50
Max. Negotiated Rate	$1,242.57
Rate for Payer: AlohaCare Medicaid	$640.50
Rate for Payer: AlohaCare Medicare	$640.50
Rate for Payer: Cash Price	$832.65
Rate for Payer: Devoted Health Medicare	$704.55
Rate for Payer: Hawaii Medical Service Association Medicare	$640.50
Rate for Payer: Hawaii Western Management Group Commercial	$896.70
Rate for Payer: Health Management Network Commercial	$1,088.85
Rate for Payer: Humana Medicare	$640.50
Rate for Payer: Kaiser Permanente Commercial	$1,152.90
Rate for Payer: Kaiser Permanente Medicaid	$653.31
Rate for Payer: Kaiser Permanente Medicare	$640.50
Rate for Payer: MDX Hawaii PPO	$1,242.57
Rate for Payer: Ohana Health Plan Medicaid	$640.50
Rate for Payer: Ohana Health Plan Medicare	$640.50
Rate for Payer: UnitedHealthcare Medicare	$640.50
Rate for Payer: University Health Alliance Commercial	$717.36

ORTHO: LCP ONE-THIRD TUBULAR PLATE 10 HOLE

Facility

$1,281.00

Service Code	HCPCS C1713
Hospital Charge Code	9595027
Hospital Revenue Code	278
Min. Negotiated Rate	$717.36
Max. Negotiated Rate	$1,242.57
Rate for Payer: Cash Price	$832.65
Rate for Payer: Hawaii Western Management Group Commercial	$896.70
Rate for Payer: Health Management Network Commercial	$1,088.85
Rate for Payer: Kaiser Permanente Commercial	$1,152.90
Rate for Payer: MDX Hawaii PPO	$1,242.57
Rate for Payer: University Health Alliance Commercial	$717.36

ORTHO:LO-PRO SCRW CANNULA BLUNT TIP 4 X 34MM

Facility

$649.00

Service Code	HCPCS C1713
Hospital Charge Code	13241685
Hospital Revenue Code	278
Min. Negotiated Rate	$324.50
Max. Negotiated Rate	$629.53
Rate for Payer: AlohaCare Medicaid	$324.50
Rate for Payer: AlohaCare Medicare	$324.50
Rate for Payer: Cash Price	$421.85
Rate for Payer: Devoted Health Medicare	$356.95
Rate for Payer: Hawaii Medical Service Association Medicare	$324.50
Rate for Payer: Hawaii Western Management Group Commercial	$454.30
Rate for Payer: Health Management Network Commercial	$551.65
Rate for Payer: Humana Medicare	$324.50
Rate for Payer: Kaiser Permanente Commercial	$584.10
Rate for Payer: Kaiser Permanente Medicaid	$330.99
Rate for Payer: Kaiser Permanente Medicare	$324.50
Rate for Payer: MDX Hawaii PPO	$629.53
Rate for Payer: Ohana Health Plan Medicaid	$324.50
Rate for Payer: Ohana Health Plan Medicare	$324.50
Rate for Payer: UnitedHealthcare Medicare	$324.50
Rate for Payer: University Health Alliance Commercial	$363.44

ORTHO:LO-PRO SCRW CANNULA BLUNT TIP 4 X 34MM

Facility

$649.00

Service Code	HCPCS C1713
Hospital Charge Code	13241685
Hospital Revenue Code	278
Min. Negotiated Rate	$363.44
Max. Negotiated Rate	$629.53
Rate for Payer: Cash Price	$421.85
Rate for Payer: Hawaii Western Management Group Commercial	$454.30
Rate for Payer: Health Management Network Commercial	$551.65
Rate for Payer: Kaiser Permanente Commercial	$584.10
Rate for Payer: MDX Hawaii PPO	$629.53
Rate for Payer: University Health Alliance Commercial	$363.44

ORTHO:PATELLA SUTPLT II STAR S STRL

Facility

$5,870.00

Service Code	HCPCS C1713
Hospital Charge Code	13241684
Hospital Revenue Code	278
Min. Negotiated Rate	$2,935.00
Max. Negotiated Rate	$5,693.90
Rate for Payer: AlohaCare Medicaid	$2,935.00
Rate for Payer: AlohaCare Medicare	$2,935.00
Rate for Payer: Cash Price	$3,815.50
Rate for Payer: Devoted Health Medicare	$3,228.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,935.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,109.00
Rate for Payer: Health Management Network Commercial	$4,989.50
Rate for Payer: Humana Medicare	$2,935.00
Rate for Payer: Kaiser Permanente Commercial	$5,283.00
Rate for Payer: Kaiser Permanente Medicaid	$2,993.70
Rate for Payer: Kaiser Permanente Medicare	$2,935.00
Rate for Payer: MDX Hawaii PPO	$5,693.90
Rate for Payer: Ohana Health Plan Medicaid	$2,935.00
Rate for Payer: Ohana Health Plan Medicare	$2,935.00
Rate for Payer: UnitedHealthcare Medicare	$2,935.00
Rate for Payer: University Health Alliance Commercial	$3,287.20

ORTHO:PATELLA SUTPLT II STAR S STRL

Facility

$5,870.00

Service Code	HCPCS C1713
Hospital Charge Code	13241684
Hospital Revenue Code	278
Min. Negotiated Rate	$3,287.20
Max. Negotiated Rate	$5,693.90
Rate for Payer: Cash Price	$3,815.50
Rate for Payer: Hawaii Western Management Group Commercial	$4,109.00
Rate for Payer: Health Management Network Commercial	$4,989.50
Rate for Payer: Kaiser Permanente Commercial	$5,283.00
Rate for Payer: MDX Hawaii PPO	$5,693.90
Rate for Payer: University Health Alliance Commercial	$3,287.20

ORTHO, PROXIMAL TENODESIS IMPLANT SYSTEM REV: 0

Facility

$2,895.00

Service Code	HCPCS C1713
Hospital Charge Code	8743133
Hospital Revenue Code	278
Min. Negotiated Rate	$1,621.20
Max. Negotiated Rate	$2,808.15
Rate for Payer: Cash Price	$1,881.75
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.50
Rate for Payer: Health Management Network Commercial	$2,460.75
Rate for Payer: Kaiser Permanente Commercial	$2,605.50
Rate for Payer: MDX Hawaii PPO	$2,808.15
Rate for Payer: University Health Alliance Commercial	$1,621.20

ORTHO, PROXIMAL TENODESIS IMPLANT SYSTEM REV: 0

Facility

$2,895.00

Service Code	HCPCS C1713
Hospital Charge Code	8743133
Hospital Revenue Code	278
Min. Negotiated Rate	$1,447.50
Max. Negotiated Rate	$2,808.15
Rate for Payer: AlohaCare Medicaid	$1,447.50
Rate for Payer: AlohaCare Medicare	$1,447.50
Rate for Payer: Cash Price	$1,881.75
Rate for Payer: Devoted Health Medicare	$1,592.25
Rate for Payer: Hawaii Medical Service Association Medicare	$1,447.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.50
Rate for Payer: Health Management Network Commercial	$2,460.75
Rate for Payer: Humana Medicare	$1,447.50
Rate for Payer: Kaiser Permanente Commercial	$2,605.50
Rate for Payer: Kaiser Permanente Medicaid	$1,476.45
Rate for Payer: Kaiser Permanente Medicare	$1,447.50
Rate for Payer: MDX Hawaii PPO	$2,808.15
Rate for Payer: Ohana Health Plan Medicaid	$1,447.50
Rate for Payer: Ohana Health Plan Medicare	$1,447.50
Rate for Payer: UnitedHealthcare Medicare	$1,447.50
Rate for Payer: University Health Alliance Commercial	$1,621.20

Know your out-of-pocket cost for care.

All Charges