Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

VAL KREULOCK SCREW, TI, 2.4 X 9MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13007977
Hospital Revenue Code	278
Min. Negotiated Rate	$173.60
Max. Negotiated Rate	$300.70
Rate for Payer: Cash Price	$201.50
Rate for Payer: Hawaii Western Management Group Commercial	$217.00
Rate for Payer: Health Management Network Commercial	$263.50
Rate for Payer: Kaiser Permanente Commercial	$279.00
Rate for Payer: MDX Hawaii PPO	$300.70
Rate for Payer: University Health Alliance Commercial	$173.60

VAL KREULOCK SCREW, TI,TI,3.5MMX 12MM

Facility

$207.00

Service Code	HCPCS C1713
Hospital Charge Code	12944675
Hospital Revenue Code	278
Min. Negotiated Rate	$115.92
Max. Negotiated Rate	$200.79
Rate for Payer: Cash Price	$134.55
Rate for Payer: Hawaii Western Management Group Commercial	$144.90
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: Kaiser Permanente Commercial	$186.30
Rate for Payer: MDX Hawaii PPO	$200.79
Rate for Payer: University Health Alliance Commercial	$115.92

VAL KREULOCK SCREW, TI,TI,3.5MMX 12MM

Facility

$207.00

Service Code	HCPCS C1713
Hospital Charge Code	12944675
Hospital Revenue Code	278
Min. Negotiated Rate	$103.50
Max. Negotiated Rate	$200.79
Rate for Payer: AlohaCare Medicaid	$103.50
Rate for Payer: AlohaCare Medicare	$103.50
Rate for Payer: Cash Price	$134.55
Rate for Payer: Devoted Health Medicare	$113.85
Rate for Payer: Hawaii Medical Service Association Medicare	$103.50
Rate for Payer: Hawaii Western Management Group Commercial	$144.90
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: Humana Medicare	$103.50
Rate for Payer: Kaiser Permanente Commercial	$186.30
Rate for Payer: Kaiser Permanente Medicaid	$105.57
Rate for Payer: Kaiser Permanente Medicare	$103.50
Rate for Payer: MDX Hawaii PPO	$200.79
Rate for Payer: Ohana Health Plan Medicaid	$103.50
Rate for Payer: Ohana Health Plan Medicare	$103.50
Rate for Payer: UnitedHealthcare Medicare	$103.50
Rate for Payer: University Health Alliance Commercial	$115.92

VAL KREULOCK SCREW, TI, TITANIUM 3.5MM X 20MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	12944666
Hospital Revenue Code	278
Min. Negotiated Rate	$173.60
Max. Negotiated Rate	$300.70
Rate for Payer: Cash Price	$201.50
Rate for Payer: Hawaii Western Management Group Commercial	$217.00
Rate for Payer: Health Management Network Commercial	$263.50
Rate for Payer: Kaiser Permanente Commercial	$279.00
Rate for Payer: MDX Hawaii PPO	$300.70
Rate for Payer: University Health Alliance Commercial	$173.60

VAL KREULOCK SCREW, TI, TITANIUM 3.5MM X 20MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	12944666
Hospital Revenue Code	278
Min. Negotiated Rate	$155.00
Max. Negotiated Rate	$300.70
Rate for Payer: AlohaCare Medicaid	$155.00
Rate for Payer: AlohaCare Medicare	$155.00
Rate for Payer: Cash Price	$201.50
Rate for Payer: Devoted Health Medicare	$170.50
Rate for Payer: Hawaii Medical Service Association Medicare	$155.00
Rate for Payer: Hawaii Western Management Group Commercial	$217.00
Rate for Payer: Health Management Network Commercial	$263.50
Rate for Payer: Humana Medicare	$155.00
Rate for Payer: Kaiser Permanente Commercial	$279.00
Rate for Payer: Kaiser Permanente Medicaid	$158.10
Rate for Payer: Kaiser Permanente Medicare	$155.00
Rate for Payer: MDX Hawaii PPO	$300.70
Rate for Payer: Ohana Health Plan Medicaid	$155.00
Rate for Payer: Ohana Health Plan Medicare	$155.00
Rate for Payer: UnitedHealthcare Medicare	$155.00
Rate for Payer: University Health Alliance Commercial	$173.60

VAL KREULOCK SCREW, TI, TITANIUM 3.5MM X 22MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	12943070
Hospital Revenue Code	278
Min. Negotiated Rate	$173.60
Max. Negotiated Rate	$300.70
Rate for Payer: Cash Price	$201.50
Rate for Payer: Hawaii Western Management Group Commercial	$217.00
Rate for Payer: Health Management Network Commercial	$263.50
Rate for Payer: Kaiser Permanente Commercial	$279.00
Rate for Payer: MDX Hawaii PPO	$300.70
Rate for Payer: University Health Alliance Commercial	$173.60

VAL KREULOCK SCREW, TI, TITANIUM 3.5MM X 22MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	12943070
Hospital Revenue Code	278
Min. Negotiated Rate	$155.00
Max. Negotiated Rate	$300.70
Rate for Payer: AlohaCare Medicaid	$155.00
Rate for Payer: AlohaCare Medicare	$155.00
Rate for Payer: Cash Price	$201.50
Rate for Payer: Devoted Health Medicare	$170.50
Rate for Payer: Hawaii Medical Service Association Medicare	$155.00
Rate for Payer: Hawaii Western Management Group Commercial	$217.00
Rate for Payer: Health Management Network Commercial	$263.50
Rate for Payer: Humana Medicare	$155.00
Rate for Payer: Kaiser Permanente Commercial	$279.00
Rate for Payer: Kaiser Permanente Medicaid	$158.10
Rate for Payer: Kaiser Permanente Medicare	$155.00
Rate for Payer: MDX Hawaii PPO	$300.70
Rate for Payer: Ohana Health Plan Medicaid	$155.00
Rate for Payer: Ohana Health Plan Medicare	$155.00
Rate for Payer: UnitedHealthcare Medicare	$155.00
Rate for Payer: University Health Alliance Commercial	$173.60

VAL NEAR CORTEX SCREW, TI, 2.4 X 14MM

Facility

$184.00

Service Code	HCPCS C1713
Hospital Charge Code	13008076
Hospital Revenue Code	278
Min. Negotiated Rate	$92.00
Max. Negotiated Rate	$178.48
Rate for Payer: AlohaCare Medicaid	$92.00
Rate for Payer: AlohaCare Medicare	$92.00
Rate for Payer: Cash Price	$119.60
Rate for Payer: Devoted Health Medicare	$101.20
Rate for Payer: Hawaii Medical Service Association Medicare	$92.00
Rate for Payer: Hawaii Western Management Group Commercial	$128.80
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Humana Medicare	$92.00
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: Kaiser Permanente Medicaid	$93.84
Rate for Payer: Kaiser Permanente Medicare	$92.00
Rate for Payer: MDX Hawaii PPO	$178.48
Rate for Payer: Ohana Health Plan Medicaid	$92.00
Rate for Payer: Ohana Health Plan Medicare	$92.00
Rate for Payer: UnitedHealthcare Medicare	$92.00
Rate for Payer: University Health Alliance Commercial	$103.04

VAL NEAR CORTEX SCREW, TI, 2.4 X 14MM

Facility

$184.00

Service Code	HCPCS C1713
Hospital Charge Code	13008076
Hospital Revenue Code	278
Min. Negotiated Rate	$103.04
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$119.60
Rate for Payer: Hawaii Western Management Group Commercial	$128.80
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: MDX Hawaii PPO	$178.48
Rate for Payer: University Health Alliance Commercial	$103.04

VAL NEAR CORTEX SCREW, TI, 2.4 X 16MM

Facility

$184.00

Service Code	HCPCS C1713
Hospital Charge Code	13008079
Hospital Revenue Code	278
Min. Negotiated Rate	$103.04
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$119.60
Rate for Payer: Hawaii Western Management Group Commercial	$128.80
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: MDX Hawaii PPO	$178.48
Rate for Payer: University Health Alliance Commercial	$103.04

VAL NEAR CORTEX SCREW, TI, 2.4 X 16MM

Facility

$184.00

Service Code	HCPCS C1713
Hospital Charge Code	13008079
Hospital Revenue Code	278
Min. Negotiated Rate	$92.00
Max. Negotiated Rate	$178.48
Rate for Payer: AlohaCare Medicaid	$92.00
Rate for Payer: AlohaCare Medicare	$92.00
Rate for Payer: Cash Price	$119.60
Rate for Payer: Devoted Health Medicare	$101.20
Rate for Payer: Hawaii Medical Service Association Medicare	$92.00
Rate for Payer: Hawaii Western Management Group Commercial	$128.80
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Humana Medicare	$92.00
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: Kaiser Permanente Medicaid	$93.84
Rate for Payer: Kaiser Permanente Medicare	$92.00
Rate for Payer: MDX Hawaii PPO	$178.48
Rate for Payer: Ohana Health Plan Medicaid	$92.00
Rate for Payer: Ohana Health Plan Medicare	$92.00
Rate for Payer: UnitedHealthcare Medicare	$92.00
Rate for Payer: University Health Alliance Commercial	$103.04

VAL NEAR CORTEX SCREW, TI, 2.4 X 18MM

Facility

$147.00

Service Code	HCPCS C1713
Hospital Charge Code	13006379
Hospital Revenue Code	278
Min. Negotiated Rate	$82.32
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$95.55
Rate for Payer: Hawaii Western Management Group Commercial	$102.90
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: University Health Alliance Commercial	$82.32

VAL NEAR CORTEX SCREW, TI, 2.4 X 18MM

Facility

$147.00

Service Code	HCPCS C1713
Hospital Charge Code	13006379
Hospital Revenue Code	278
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$73.50
Rate for Payer: Cash Price	$95.55
Rate for Payer: Devoted Health Medicare	$80.85
Rate for Payer: Hawaii Medical Service Association Medicare	$73.50
Rate for Payer: Hawaii Western Management Group Commercial	$102.90
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$73.50
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$73.50
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$73.50
Rate for Payer: Ohana Health Plan Medicare	$73.50
Rate for Payer: UnitedHealthcare Medicare	$73.50
Rate for Payer: University Health Alliance Commercial	$82.32

VAL NEAR CORTEX SCREW, TI, 2.4 X 20MM

Facility

$147.00

Service Code	HCPCS C1713
Hospital Charge Code	13006378
Hospital Revenue Code	278
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$73.50
Rate for Payer: Cash Price	$95.55
Rate for Payer: Devoted Health Medicare	$80.85
Rate for Payer: Hawaii Medical Service Association Medicare	$73.50
Rate for Payer: Hawaii Western Management Group Commercial	$102.90
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$73.50
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$73.50
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$73.50
Rate for Payer: Ohana Health Plan Medicare	$73.50
Rate for Payer: UnitedHealthcare Medicare	$73.50
Rate for Payer: University Health Alliance Commercial	$82.32

VAL NEAR CORTEX SCREW, TI, 2.4 X 20MM

Facility

$147.00

Service Code	HCPCS C1713
Hospital Charge Code	13006378
Hospital Revenue Code	278
Min. Negotiated Rate	$82.32
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$95.55
Rate for Payer: Hawaii Western Management Group Commercial	$102.90
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: University Health Alliance Commercial	$82.32

VAL NEAR CORTEX SCREW, TI, 2.4 X 22MM

Facility

$147.00

Service Code	HCPCS C1713
Hospital Charge Code	13006377
Hospital Revenue Code	278
Min. Negotiated Rate	$82.32
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$95.55
Rate for Payer: Hawaii Western Management Group Commercial	$102.90
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: University Health Alliance Commercial	$82.32

VAL NEAR CORTEX SCREW, TI, 2.4 X 22MM

Facility

$147.00

Service Code	HCPCS C1713
Hospital Charge Code	13006377
Hospital Revenue Code	278
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$73.50
Rate for Payer: Cash Price	$95.55
Rate for Payer: Devoted Health Medicare	$80.85
Rate for Payer: Hawaii Medical Service Association Medicare	$73.50
Rate for Payer: Hawaii Western Management Group Commercial	$102.90
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$73.50
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$73.50
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$73.50
Rate for Payer: Ohana Health Plan Medicare	$73.50
Rate for Payer: UnitedHealthcare Medicare	$73.50
Rate for Payer: University Health Alliance Commercial	$82.32

VAL NEAR CORTEX SCREW, TI, 2.4 X 24MM

Facility

$147.00

Service Code	HCPCS C1713
Hospital Charge Code	13006380
Hospital Revenue Code	278
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$73.50
Rate for Payer: Cash Price	$95.55
Rate for Payer: Devoted Health Medicare	$80.85
Rate for Payer: Hawaii Medical Service Association Medicare	$73.50
Rate for Payer: Hawaii Western Management Group Commercial	$102.90
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$73.50
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$73.50
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$73.50
Rate for Payer: Ohana Health Plan Medicare	$73.50
Rate for Payer: UnitedHealthcare Medicare	$73.50
Rate for Payer: University Health Alliance Commercial	$82.32

VAL NEAR CORTEX SCREW, TI, 2.4 X 24MM

Facility

$147.00

Service Code	HCPCS C1713
Hospital Charge Code	13006380
Hospital Revenue Code	278
Min. Negotiated Rate	$82.32
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$95.55
Rate for Payer: Hawaii Western Management Group Commercial	$102.90
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: University Health Alliance Commercial	$82.32

VAL NEAR CORTEX SCREW, TI, 2.4 X 26MM

Facility

$147.00

Service Code	HCPCS C1713
Hospital Charge Code	13002812
Hospital Revenue Code	278
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$73.50
Rate for Payer: Cash Price	$95.55
Rate for Payer: Devoted Health Medicare	$80.85
Rate for Payer: Hawaii Medical Service Association Medicare	$73.50
Rate for Payer: Hawaii Western Management Group Commercial	$102.90
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$73.50
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$73.50
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$73.50
Rate for Payer: Ohana Health Plan Medicare	$73.50
Rate for Payer: UnitedHealthcare Medicare	$73.50
Rate for Payer: University Health Alliance Commercial	$82.32

VAL NEAR CORTEX SCREW, TI, 2.4 X 26MM

Facility

$147.00

Service Code	HCPCS C1713
Hospital Charge Code	13002812
Hospital Revenue Code	278
Min. Negotiated Rate	$82.32
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$95.55
Rate for Payer: Hawaii Western Management Group Commercial	$102.90
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: University Health Alliance Commercial	$82.32

VAL NEAR CORTEX SCREW, TI, 2.4 X 28MM

Facility

$147.00

Service Code	HCPCS C1713
Hospital Charge Code	13002813
Hospital Revenue Code	278
Min. Negotiated Rate	$82.32
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$95.55
Rate for Payer: Hawaii Western Management Group Commercial	$102.90
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: University Health Alliance Commercial	$82.32

VAL NEAR CORTEX SCREW, TI, 2.4 X 28MM

Facility

$147.00

Service Code	HCPCS C1713
Hospital Charge Code	13002813
Hospital Revenue Code	278
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$73.50
Rate for Payer: Cash Price	$95.55
Rate for Payer: Devoted Health Medicare	$80.85
Rate for Payer: Hawaii Medical Service Association Medicare	$73.50
Rate for Payer: Hawaii Western Management Group Commercial	$102.90
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$73.50
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$73.50
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$73.50
Rate for Payer: Ohana Health Plan Medicare	$73.50
Rate for Payer: UnitedHealthcare Medicare	$73.50
Rate for Payer: University Health Alliance Commercial	$82.32

VAL NEAR CORTEX SCREW, TI, 2.4 X 30MM

Facility

$184.00

Service Code	HCPCS C1713
Hospital Charge Code	13002814
Hospital Revenue Code	278
Min. Negotiated Rate	$103.04
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$119.60
Rate for Payer: Hawaii Western Management Group Commercial	$128.80
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: MDX Hawaii PPO	$178.48
Rate for Payer: University Health Alliance Commercial	$103.04

VAL NEAR CORTEX SCREW, TI, 2.4 X 30MM

Facility

$184.00

Service Code	HCPCS C1713
Hospital Charge Code	13002814
Hospital Revenue Code	278
Min. Negotiated Rate	$92.00
Max. Negotiated Rate	$178.48
Rate for Payer: AlohaCare Medicaid	$92.00
Rate for Payer: AlohaCare Medicare	$92.00
Rate for Payer: Cash Price	$119.60
Rate for Payer: Devoted Health Medicare	$101.20
Rate for Payer: Hawaii Medical Service Association Medicare	$92.00
Rate for Payer: Hawaii Western Management Group Commercial	$128.80
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Humana Medicare	$92.00
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: Kaiser Permanente Medicaid	$93.84
Rate for Payer: Kaiser Permanente Medicare	$92.00
Rate for Payer: MDX Hawaii PPO	$178.48
Rate for Payer: Ohana Health Plan Medicaid	$92.00
Rate for Payer: Ohana Health Plan Medicare	$92.00
Rate for Payer: UnitedHealthcare Medicare	$92.00
Rate for Payer: University Health Alliance Commercial	$103.04

Know your out-of-pocket cost for care.

All Charges