Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Toxoplasmosis IgG and IgM (Palo Alto) FSI

Facility

$114.00

Service Code	HCPCS 86777
Hospital Charge Code	10004696
Hospital Revenue Code	302
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$74.10
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Kaiser Permanente Commercial	$102.60
Rate for Payer: MDX Hawaii PPO	$110.58

T-PLATE, 2.0MM, 6 HOLE

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13000863
Hospital Revenue Code	278
Min. Negotiated Rate	$818.72
Max. Negotiated Rate	$1,418.14
Rate for Payer: Cash Price	$950.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: University Health Alliance Commercial	$818.72

T-PLATE, 2.0MM, 6 HOLE

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13000863
Hospital Revenue Code	278
Min. Negotiated Rate	$731.00
Max. Negotiated Rate	$1,418.14
Rate for Payer: AlohaCare Medicaid	$731.00
Rate for Payer: AlohaCare Medicare	$731.00
Rate for Payer: Cash Price	$950.30
Rate for Payer: Devoted Health Medicare	$804.10
Rate for Payer: Hawaii Medical Service Association Medicare	$731.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Humana Medicare	$731.00
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: Kaiser Permanente Medicaid	$745.62
Rate for Payer: Kaiser Permanente Medicare	$731.00
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: Ohana Health Plan Medicaid	$731.00
Rate for Payer: Ohana Health Plan Medicare	$731.00
Rate for Payer: UnitedHealthcare Medicare	$731.00
Rate for Payer: University Health Alliance Commercial	$818.72

T-PLATE, 2.0MM, 6 HOLE, REINFORCED

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13000874
Hospital Revenue Code	278
Min. Negotiated Rate	$731.00
Max. Negotiated Rate	$1,418.14
Rate for Payer: AlohaCare Medicaid	$731.00
Rate for Payer: AlohaCare Medicare	$731.00
Rate for Payer: Cash Price	$950.30
Rate for Payer: Devoted Health Medicare	$804.10
Rate for Payer: Hawaii Medical Service Association Medicare	$731.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Humana Medicare	$731.00
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: Kaiser Permanente Medicaid	$745.62
Rate for Payer: Kaiser Permanente Medicare	$731.00
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: Ohana Health Plan Medicaid	$731.00
Rate for Payer: Ohana Health Plan Medicare	$731.00
Rate for Payer: UnitedHealthcare Medicare	$731.00
Rate for Payer: University Health Alliance Commercial	$818.72

T-PLATE, 2.0MM, 6 HOLE, REINFORCED

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13000874
Hospital Revenue Code	278
Min. Negotiated Rate	$818.72
Max. Negotiated Rate	$1,418.14
Rate for Payer: Cash Price	$950.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: University Health Alliance Commercial	$818.72

T-PLATE, 2.0MM, 8 HOLE

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13000875
Hospital Revenue Code	278
Min. Negotiated Rate	$731.00
Max. Negotiated Rate	$1,418.14
Rate for Payer: AlohaCare Medicaid	$731.00
Rate for Payer: AlohaCare Medicare	$731.00
Rate for Payer: Cash Price	$950.30
Rate for Payer: Devoted Health Medicare	$804.10
Rate for Payer: Hawaii Medical Service Association Medicare	$731.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Humana Medicare	$731.00
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: Kaiser Permanente Medicaid	$745.62
Rate for Payer: Kaiser Permanente Medicare	$731.00
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: Ohana Health Plan Medicaid	$731.00
Rate for Payer: Ohana Health Plan Medicare	$731.00
Rate for Payer: UnitedHealthcare Medicare	$731.00
Rate for Payer: University Health Alliance Commercial	$818.72

T-PLATE, 2.0MM, 8 HOLE

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13000875
Hospital Revenue Code	278
Min. Negotiated Rate	$818.72
Max. Negotiated Rate	$1,418.14
Rate for Payer: Cash Price	$950.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: University Health Alliance Commercial	$818.72

T-PLATE, 2.0MM, 8 HOLE, REINFORCED

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13000880
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$2,429.85
Rate for Payer: AlohaCare Medicaid	$1,252.50
Rate for Payer: AlohaCare Medicare	$1,252.50
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Devoted Health Medicare	$1,377.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,252.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Humana Medicare	$1,252.50
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: Kaiser Permanente Medicaid	$1,277.55
Rate for Payer: Kaiser Permanente Medicare	$1,252.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: Ohana Health Plan Medicaid	$1,252.50
Rate for Payer: Ohana Health Plan Medicare	$1,252.50
Rate for Payer: UnitedHealthcare Medicare	$1,252.50
Rate for Payer: University Health Alliance Commercial	$1,402.80

T-PLATE, 2.0MM, 8 HOLE, REINFORCED

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13000880
Hospital Revenue Code	278
Min. Negotiated Rate	$1,402.80
Max. Negotiated Rate	$2,429.85
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: University Health Alliance Commercial	$1,402.80

T-PLATE, 2.4MM, 6 HOLE

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13000876
Hospital Revenue Code	278
Min. Negotiated Rate	$818.72
Max. Negotiated Rate	$1,418.14
Rate for Payer: Cash Price	$950.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: University Health Alliance Commercial	$818.72

T-PLATE, 2.4MM, 6 HOLE

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13000876
Hospital Revenue Code	278
Min. Negotiated Rate	$731.00
Max. Negotiated Rate	$1,418.14
Rate for Payer: AlohaCare Medicaid	$731.00
Rate for Payer: AlohaCare Medicare	$731.00
Rate for Payer: Cash Price	$950.30
Rate for Payer: Devoted Health Medicare	$804.10
Rate for Payer: Hawaii Medical Service Association Medicare	$731.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Humana Medicare	$731.00
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: Kaiser Permanente Medicaid	$745.62
Rate for Payer: Kaiser Permanente Medicare	$731.00
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: Ohana Health Plan Medicaid	$731.00
Rate for Payer: Ohana Health Plan Medicare	$731.00
Rate for Payer: UnitedHealthcare Medicare	$731.00
Rate for Payer: University Health Alliance Commercial	$818.72

T-PLATE, 2.4MM, 6 HOLE,REINFORCED

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13000877
Hospital Revenue Code	278
Min. Negotiated Rate	$731.00
Max. Negotiated Rate	$1,418.14
Rate for Payer: AlohaCare Medicaid	$731.00
Rate for Payer: AlohaCare Medicare	$731.00
Rate for Payer: Cash Price	$950.30
Rate for Payer: Devoted Health Medicare	$804.10
Rate for Payer: Hawaii Medical Service Association Medicare	$731.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Humana Medicare	$731.00
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: Kaiser Permanente Medicaid	$745.62
Rate for Payer: Kaiser Permanente Medicare	$731.00
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: Ohana Health Plan Medicaid	$731.00
Rate for Payer: Ohana Health Plan Medicare	$731.00
Rate for Payer: UnitedHealthcare Medicare	$731.00
Rate for Payer: University Health Alliance Commercial	$818.72

T-PLATE, 2.4MM, 6 HOLE,REINFORCED

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13000877
Hospital Revenue Code	278
Min. Negotiated Rate	$818.72
Max. Negotiated Rate	$1,418.14
Rate for Payer: Cash Price	$950.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: University Health Alliance Commercial	$818.72

T-PLATE, 2.4MM, 8 HOLE

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13000882
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$2,429.85
Rate for Payer: AlohaCare Medicaid	$1,252.50
Rate for Payer: AlohaCare Medicare	$1,252.50
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Devoted Health Medicare	$1,377.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,252.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Humana Medicare	$1,252.50
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: Kaiser Permanente Medicaid	$1,277.55
Rate for Payer: Kaiser Permanente Medicare	$1,252.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: Ohana Health Plan Medicaid	$1,252.50
Rate for Payer: Ohana Health Plan Medicare	$1,252.50
Rate for Payer: UnitedHealthcare Medicare	$1,252.50
Rate for Payer: University Health Alliance Commercial	$1,402.80

T-PLATE, 2.4MM, 8 HOLE

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13000882
Hospital Revenue Code	278
Min. Negotiated Rate	$1,402.80
Max. Negotiated Rate	$2,429.85
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: University Health Alliance Commercial	$1,402.80

T-PLATE, 2.4MM, 8 HOLE,REINFORCED

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13000883
Hospital Revenue Code	278
Min. Negotiated Rate	$1,402.80
Max. Negotiated Rate	$2,429.85
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: University Health Alliance Commercial	$1,402.80

T-PLATE, 2.4MM, 8 HOLE,REINFORCED

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13000883
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$2,429.85
Rate for Payer: AlohaCare Medicaid	$1,252.50
Rate for Payer: AlohaCare Medicare	$1,252.50
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Devoted Health Medicare	$1,377.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,252.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Humana Medicare	$1,252.50
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: Kaiser Permanente Medicaid	$1,277.55
Rate for Payer: Kaiser Permanente Medicare	$1,252.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: Ohana Health Plan Medicaid	$1,252.50
Rate for Payer: Ohana Health Plan Medicare	$1,252.50
Rate for Payer: UnitedHealthcare Medicare	$1,252.50
Rate for Payer: University Health Alliance Commercial	$1,402.80

T-PLATE, 2.7MM, 2 HOLE HEAD, 10 HOLE

Facility

$2,510.00

Service Code	HCPCS C1713
Hospital Charge Code	13000884
Hospital Revenue Code	278
Min. Negotiated Rate	$1,255.00
Max. Negotiated Rate	$2,434.70
Rate for Payer: AlohaCare Medicaid	$1,255.00
Rate for Payer: AlohaCare Medicare	$1,255.00
Rate for Payer: Cash Price	$1,631.50
Rate for Payer: Devoted Health Medicare	$1,380.50
Rate for Payer: Hawaii Medical Service Association Medicare	$1,255.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,757.00
Rate for Payer: Health Management Network Commercial	$2,133.50
Rate for Payer: Humana Medicare	$1,255.00
Rate for Payer: Kaiser Permanente Commercial	$2,259.00
Rate for Payer: Kaiser Permanente Medicaid	$1,280.10
Rate for Payer: Kaiser Permanente Medicare	$1,255.00
Rate for Payer: MDX Hawaii PPO	$2,434.70
Rate for Payer: Ohana Health Plan Medicaid	$1,255.00
Rate for Payer: Ohana Health Plan Medicare	$1,255.00
Rate for Payer: UnitedHealthcare Medicare	$1,255.00
Rate for Payer: University Health Alliance Commercial	$1,405.60

T-PLATE, 2.7MM, 2 HOLE HEAD, 10 HOLE

Facility

$2,510.00

Service Code	HCPCS C1713
Hospital Charge Code	13000884
Hospital Revenue Code	278
Min. Negotiated Rate	$1,405.60
Max. Negotiated Rate	$2,434.70
Rate for Payer: Cash Price	$1,631.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,757.00
Rate for Payer: Health Management Network Commercial	$2,133.50
Rate for Payer: Kaiser Permanente Commercial	$2,259.00
Rate for Payer: MDX Hawaii PPO	$2,434.70
Rate for Payer: University Health Alliance Commercial	$1,405.60

T-PLATE, 2.7MM, 2 HOLE HEAD, 6 HOLE

Facility

$2,510.00

Service Code	HCPCS C1713
Hospital Charge Code	13000878
Hospital Revenue Code	278
Min. Negotiated Rate	$1,405.60
Max. Negotiated Rate	$2,434.70
Rate for Payer: Cash Price	$1,631.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,757.00
Rate for Payer: Health Management Network Commercial	$2,133.50
Rate for Payer: Kaiser Permanente Commercial	$2,259.00
Rate for Payer: MDX Hawaii PPO	$2,434.70
Rate for Payer: University Health Alliance Commercial	$1,405.60

T-PLATE, 2.7MM, 2 HOLE HEAD, 6 HOLE

Facility

$2,510.00

Service Code	HCPCS C1713
Hospital Charge Code	13000878
Hospital Revenue Code	278
Min. Negotiated Rate	$1,255.00
Max. Negotiated Rate	$2,434.70
Rate for Payer: AlohaCare Medicaid	$1,255.00
Rate for Payer: AlohaCare Medicare	$1,255.00
Rate for Payer: Cash Price	$1,631.50
Rate for Payer: Devoted Health Medicare	$1,380.50
Rate for Payer: Hawaii Medical Service Association Medicare	$1,255.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,757.00
Rate for Payer: Health Management Network Commercial	$2,133.50
Rate for Payer: Humana Medicare	$1,255.00
Rate for Payer: Kaiser Permanente Commercial	$2,259.00
Rate for Payer: Kaiser Permanente Medicaid	$1,280.10
Rate for Payer: Kaiser Permanente Medicare	$1,255.00
Rate for Payer: MDX Hawaii PPO	$2,434.70
Rate for Payer: Ohana Health Plan Medicaid	$1,255.00
Rate for Payer: Ohana Health Plan Medicare	$1,255.00
Rate for Payer: UnitedHealthcare Medicare	$1,255.00
Rate for Payer: University Health Alliance Commercial	$1,405.60

T-PLATE, 2.7MM, 3 HOLE HEAD, 10 HOLE

Facility

$1,883.00

Service Code	HCPCS C1713
Hospital Charge Code	13000881
Hospital Revenue Code	278
Min. Negotiated Rate	$941.50
Max. Negotiated Rate	$1,826.51
Rate for Payer: AlohaCare Medicaid	$941.50
Rate for Payer: AlohaCare Medicare	$941.50
Rate for Payer: Cash Price	$1,223.95
Rate for Payer: Devoted Health Medicare	$1,035.65
Rate for Payer: Hawaii Medical Service Association Medicare	$941.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,318.10
Rate for Payer: Health Management Network Commercial	$1,600.55
Rate for Payer: Humana Medicare	$941.50
Rate for Payer: Kaiser Permanente Commercial	$1,694.70
Rate for Payer: Kaiser Permanente Medicaid	$960.33
Rate for Payer: Kaiser Permanente Medicare	$941.50
Rate for Payer: MDX Hawaii PPO	$1,826.51
Rate for Payer: Ohana Health Plan Medicaid	$941.50
Rate for Payer: Ohana Health Plan Medicare	$941.50
Rate for Payer: UnitedHealthcare Medicare	$941.50
Rate for Payer: University Health Alliance Commercial	$1,054.48

T-PLATE, 2.7MM, 3 HOLE HEAD, 10 HOLE

Facility

$1,883.00

Service Code	HCPCS C1713
Hospital Charge Code	13000881
Hospital Revenue Code	278
Min. Negotiated Rate	$1,054.48
Max. Negotiated Rate	$1,826.51
Rate for Payer: Cash Price	$1,223.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,318.10
Rate for Payer: Health Management Network Commercial	$1,600.55
Rate for Payer: Kaiser Permanente Commercial	$1,694.70
Rate for Payer: MDX Hawaii PPO	$1,826.51
Rate for Payer: University Health Alliance Commercial	$1,054.48

T-PLATE, 2.7MM, 3 HOLE HEAD, 6 HOLE

Facility

$1,883.00

Service Code	HCPCS C1713
Hospital Charge Code	13000879
Hospital Revenue Code	278
Min. Negotiated Rate	$941.50
Max. Negotiated Rate	$1,826.51
Rate for Payer: AlohaCare Medicaid	$941.50
Rate for Payer: AlohaCare Medicare	$941.50
Rate for Payer: Cash Price	$1,223.95
Rate for Payer: Devoted Health Medicare	$1,035.65
Rate for Payer: Hawaii Medical Service Association Medicare	$941.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,318.10
Rate for Payer: Health Management Network Commercial	$1,600.55
Rate for Payer: Humana Medicare	$941.50
Rate for Payer: Kaiser Permanente Commercial	$1,694.70
Rate for Payer: Kaiser Permanente Medicaid	$960.33
Rate for Payer: Kaiser Permanente Medicare	$941.50
Rate for Payer: MDX Hawaii PPO	$1,826.51
Rate for Payer: Ohana Health Plan Medicaid	$941.50
Rate for Payer: Ohana Health Plan Medicare	$941.50
Rate for Payer: UnitedHealthcare Medicare	$941.50
Rate for Payer: University Health Alliance Commercial	$1,054.48

T-PLATE, 2.7MM, 3 HOLE HEAD, 6 HOLE

Facility

$1,883.00

Service Code	HCPCS C1713
Hospital Charge Code	13000879
Hospital Revenue Code	278
Min. Negotiated Rate	$1,054.48
Max. Negotiated Rate	$1,826.51
Rate for Payer: Cash Price	$1,223.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,318.10
Rate for Payer: Health Management Network Commercial	$1,600.55
Rate for Payer: Kaiser Permanente Commercial	$1,694.70
Rate for Payer: MDX Hawaii PPO	$1,826.51
Rate for Payer: University Health Alliance Commercial	$1,054.48

Know your out-of-pocket cost for care.

All Charges