Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

VAL VAL KREULOCK SCREW, TI, 2.7 MM X 22 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017650
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 VAL KREULOCK SCREW, TI, 2.7 MM X 24 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017659
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 VAL KREULOCK SCREW, TI, 2.7 MM X 24 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017659
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 VAL KREULOCK SCREW, TI, 2.7 MM X 36 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017675
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 VAL KREULOCK SCREW, TI, 2.7 MM X 36 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017675
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 VAL KREULOCK SCREW, TI, 2.7 MM X 38 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017676
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 VAL KREULOCK SCREW, TI, 2.7 MM X 38 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017676
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 VAL KREULOCK SCREW, TI, 2.7 MM X 40 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017681
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 VAL KREULOCK SCREW, TI, 2.7 MM X 40 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017681
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 VAL KREULOCK SCREW, TI, 2.7 MM X 42 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017673
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 VAL KREULOCK SCREW, TI, 2.7 MM X 42 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017673
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 VAL KREULOCK SCREW, TI, 2.7 MM X 44 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017682
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 VAL KREULOCK SCREW, TI, 2.7 MM X 44 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017682
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 VAL KREULOCK SCREW, TI, 2.7 MM X 46 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017683
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 VAL KREULOCK SCREW, TI, 2.7 MM X 46 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017683
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 VAL KREULOCK SCREW, TI, 2.7 MM X 48 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017685
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 VAL KREULOCK SCREW, TI, 2.7 MM X 48 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017685
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 VAL KREULOCK SCREW, TI, 2.7 MM X 50 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017686
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 VAL KREULOCK SCREW, TI, 2.7 MM X 50 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017686
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 VAL KREULOCK SCREW, TI, 2.7 MM X 55 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017677
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 VAL KREULOCK SCREW, TI, 2.7 MM X 55 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017677
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 VAL KREULOCK SCREW, TI, 2.7 MM X 60 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017684
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 VAL KREULOCK SCREW, TI, 2.7 MM X 60 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017684
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 VAL KREULOCK SCREW, TI, 2.7 MM X 65 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017687
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 VAL KREULOCK SCREW, TI, 2.7 MM X 65 MM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	13017687
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

Know your out-of-pocket cost for care.

All Charges