Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

clotrimazole 1% cream topical [HHSC]

Facility

$51.51

Service Code	NDC 45802043411
Hospital Charge Code	2500197
Hospital Revenue Code	250
Min. Negotiated Rate	$43.78
Max. Negotiated Rate	$49.96
Rate for Payer: Cash Price	$33.48
Rate for Payer: Health Management Network Commercial	$43.78
Rate for Payer: Kaiser Permanente Commercial	$46.36
Rate for Payer: MDX Hawaii PPO	$49.96

clotrimazole 1% cream topical [HHSC]

Facility

$50.78

Service Code	NDC 24385020503
Hospital Charge Code	2500197
Hospital Revenue Code	250
Min. Negotiated Rate	$43.16
Max. Negotiated Rate	$49.26
Rate for Payer: Cash Price	$33.01
Rate for Payer: Health Management Network Commercial	$43.16
Rate for Payer: Kaiser Permanente Commercial	$45.70
Rate for Payer: MDX Hawaii PPO	$49.26

clotrimazole 1% cream topical [HHSC]

Facility

$52.40

Service Code	NDC 00904782231
Hospital Charge Code	2500197
Hospital Revenue Code	250
Min. Negotiated Rate	$26.20
Max. Negotiated Rate	$50.83
Rate for Payer: AlohaCare Medicaid	$26.20
Rate for Payer: AlohaCare Medicare	$26.20
Rate for Payer: Cash Price	$34.06
Rate for Payer: Devoted Health Medicare	$28.82
Rate for Payer: Hawaii Medical Service Association Medicare	$26.20
Rate for Payer: Hawaii Western Management Group Commercial	$49.78
Rate for Payer: Health Management Network Commercial	$44.54
Rate for Payer: Humana Medicare	$26.20
Rate for Payer: Kaiser Permanente Commercial	$47.16
Rate for Payer: Kaiser Permanente Medicaid	$26.72
Rate for Payer: Kaiser Permanente Medicare	$26.20
Rate for Payer: MDX Hawaii PPO	$50.83
Rate for Payer: Ohana Health Plan Medicaid	$26.20
Rate for Payer: Ohana Health Plan Medicare	$26.20
Rate for Payer: UnitedHealthcare Medicaid	$31.44
Rate for Payer: UnitedHealthcare Medicare	$26.20
Rate for Payer: University Health Alliance Commercial	$38.19

clotrimazole 1% cream topical [HHSC]

Facility

$52.40

Service Code	NDC 00904782231
Hospital Charge Code	2500197
Hospital Revenue Code	250
Min. Negotiated Rate	$44.54
Max. Negotiated Rate	$50.83
Rate for Payer: Cash Price	$34.06
Rate for Payer: Health Management Network Commercial	$44.54
Rate for Payer: Kaiser Permanente Commercial	$47.16
Rate for Payer: MDX Hawaii PPO	$50.83

clotrimazole 1% cream topical [HHSC]

Facility

$64.13

Service Code	NDC 51672200202
Hospital Charge Code	2500197
Hospital Revenue Code	250
Min. Negotiated Rate	$54.51
Max. Negotiated Rate	$62.21
Rate for Payer: Cash Price	$41.68
Rate for Payer: Health Management Network Commercial	$54.51
Rate for Payer: Kaiser Permanente Commercial	$57.72
Rate for Payer: MDX Hawaii PPO	$62.21

clotrimazole 1% cream topical [HHSC]

Facility

$50.78

Service Code	NDC 24385020503
Hospital Charge Code	2500197
Hospital Revenue Code	250
Min. Negotiated Rate	$25.39
Max. Negotiated Rate	$49.26
Rate for Payer: AlohaCare Medicaid	$25.39
Rate for Payer: AlohaCare Medicare	$25.39
Rate for Payer: Cash Price	$33.01
Rate for Payer: Devoted Health Medicare	$27.93
Rate for Payer: Hawaii Medical Service Association Medicare	$25.39
Rate for Payer: Hawaii Western Management Group Commercial	$48.24
Rate for Payer: Health Management Network Commercial	$43.16
Rate for Payer: Humana Medicare	$25.39
Rate for Payer: Kaiser Permanente Commercial	$45.70
Rate for Payer: Kaiser Permanente Medicaid	$25.90
Rate for Payer: Kaiser Permanente Medicare	$25.39
Rate for Payer: MDX Hawaii PPO	$49.26
Rate for Payer: Ohana Health Plan Medicaid	$25.39
Rate for Payer: Ohana Health Plan Medicare	$25.39
Rate for Payer: UnitedHealthcare Medicaid	$30.47
Rate for Payer: UnitedHealthcare Medicare	$25.39
Rate for Payer: University Health Alliance Commercial	$37.01

clotrimazole 1% cream topical [HHSC]

Facility

$64.13

Service Code	NDC 51672200202
Hospital Charge Code	2500197
Hospital Revenue Code	250
Min. Negotiated Rate	$32.06
Max. Negotiated Rate	$62.21
Rate for Payer: AlohaCare Medicaid	$32.06
Rate for Payer: AlohaCare Medicare	$32.06
Rate for Payer: Cash Price	$41.68
Rate for Payer: Devoted Health Medicare	$35.27
Rate for Payer: Hawaii Medical Service Association Medicare	$32.06
Rate for Payer: Hawaii Western Management Group Commercial	$60.92
Rate for Payer: Health Management Network Commercial	$54.51
Rate for Payer: Humana Medicare	$32.06
Rate for Payer: Kaiser Permanente Commercial	$57.72
Rate for Payer: Kaiser Permanente Medicaid	$32.71
Rate for Payer: Kaiser Permanente Medicare	$32.06
Rate for Payer: MDX Hawaii PPO	$62.21
Rate for Payer: Ohana Health Plan Medicaid	$32.06
Rate for Payer: Ohana Health Plan Medicare	$32.06
Rate for Payer: UnitedHealthcare Medicaid	$38.48
Rate for Payer: UnitedHealthcare Medicare	$32.06
Rate for Payer: University Health Alliance Commercial	$46.74

clotrimazole 1% cream topical [HHSC]

Facility

$54.50

Service Code	NDC 68001047547
Hospital Charge Code	2500197
Hospital Revenue Code	250
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$52.87
Rate for Payer: AlohaCare Medicaid	$27.25
Rate for Payer: AlohaCare Medicare	$27.25
Rate for Payer: Cash Price	$35.43
Rate for Payer: Devoted Health Medicare	$29.98
Rate for Payer: Hawaii Medical Service Association Medicare	$27.25
Rate for Payer: Hawaii Western Management Group Commercial	$51.77
Rate for Payer: Health Management Network Commercial	$46.33
Rate for Payer: Humana Medicare	$27.25
Rate for Payer: Kaiser Permanente Commercial	$49.05
Rate for Payer: Kaiser Permanente Medicaid	$27.80
Rate for Payer: Kaiser Permanente Medicare	$27.25
Rate for Payer: MDX Hawaii PPO	$52.87
Rate for Payer: Ohana Health Plan Medicaid	$27.25
Rate for Payer: Ohana Health Plan Medicare	$27.25
Rate for Payer: UnitedHealthcare Medicaid	$32.70
Rate for Payer: UnitedHealthcare Medicare	$27.25
Rate for Payer: University Health Alliance Commercial	$39.73

clotrimazole 1% cream topical [HHSC]

Facility

$51.51

Service Code	NDC 45802043411
Hospital Charge Code	2500197
Hospital Revenue Code	250
Min. Negotiated Rate	$25.75
Max. Negotiated Rate	$49.96
Rate for Payer: AlohaCare Medicaid	$25.75
Rate for Payer: AlohaCare Medicare	$25.75
Rate for Payer: Cash Price	$33.48
Rate for Payer: Devoted Health Medicare	$28.33
Rate for Payer: Hawaii Medical Service Association Medicare	$25.75
Rate for Payer: Hawaii Western Management Group Commercial	$48.93
Rate for Payer: Health Management Network Commercial	$43.78
Rate for Payer: Humana Medicare	$25.75
Rate for Payer: Kaiser Permanente Commercial	$46.36
Rate for Payer: Kaiser Permanente Medicaid	$26.27
Rate for Payer: Kaiser Permanente Medicare	$25.75
Rate for Payer: MDX Hawaii PPO	$49.96
Rate for Payer: Ohana Health Plan Medicaid	$25.75
Rate for Payer: Ohana Health Plan Medicare	$25.75
Rate for Payer: UnitedHealthcare Medicaid	$30.91
Rate for Payer: UnitedHealthcare Medicare	$25.75
Rate for Payer: University Health Alliance Commercial	$37.55

Clozapine FSI

Facility

$206.00

Service Code	HCPCS 83789
Hospital Charge Code	8228857
Hospital Revenue Code	301
Min. Negotiated Rate	$175.10
Max. Negotiated Rate	$199.82
Rate for Payer: Cash Price	$133.90
Rate for Payer: Health Management Network Commercial	$175.10
Rate for Payer: Kaiser Permanente Commercial	$185.40
Rate for Payer: MDX Hawaii PPO	$199.82

Clozapine FSI

Facility

$206.00

Service Code	HCPCS 83789
Hospital Charge Code	8228857
Hospital Revenue Code	301
Min. Negotiated Rate	$24.11
Max. Negotiated Rate	$199.82
Rate for Payer: AlohaCare Medicaid	$103.00
Rate for Payer: AlohaCare Medicare	$103.00
Rate for Payer: Cash Price	$133.90
Rate for Payer: Cash Price	$133.90
Rate for Payer: Devoted Health Medicare	$113.30
Rate for Payer: Hawaii Medical Service Association ABD	$24.96
Rate for Payer: Hawaii Medical Service Association Commercial	$30.14
Rate for Payer: Hawaii Medical Service Association Medicare	$103.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.21
Rate for Payer: Hawaii Western Management Group Commercial	$24.11
Rate for Payer: Health Management Network Commercial	$175.10
Rate for Payer: Humana Medicare	$103.00
Rate for Payer: Kaiser Permanente Commercial	$185.40
Rate for Payer: Kaiser Permanente Medicaid	$105.06
Rate for Payer: Kaiser Permanente Medicare	$103.00
Rate for Payer: MDX Hawaii PPO	$199.82
Rate for Payer: Ohana Health Plan Medicaid	$103.00
Rate for Payer: Ohana Health Plan Medicare	$103.00
Rate for Payer: UnitedHealthcare Medicaid	$24.96
Rate for Payer: UnitedHealthcare Medicare	$103.00
Rate for Payer: University Health Alliance Commercial	$46.68

COAGULATION DISORDERS

Facility

$34,700.06

Service Code	MSDRG 813
Min. Negotiated Rate	$34,700.06
Max. Negotiated Rate	$34,700.06
Rate for Payer: Hawaii Medical Service Association Commercial	$34,700.06

Cocaine, Urine Screen FSI

Facility

$1,384.00

Service Code	HCPCS 80307
Hospital Charge Code	8228858
Hospital Revenue Code	301
Min. Negotiated Rate	$1,176.40
Max. Negotiated Rate	$1,342.48
Rate for Payer: Cash Price	$899.60
Rate for Payer: Health Management Network Commercial	$1,176.40
Rate for Payer: Kaiser Permanente Commercial	$1,245.60
Rate for Payer: MDX Hawaii PPO	$1,342.48

Cocaine, Urine Screen FSI

Facility

$1,384.00

Service Code	HCPCS 80307
Hospital Charge Code	8228858
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$1,342.48
Rate for Payer: AlohaCare Medicaid	$692.00
Rate for Payer: AlohaCare Medicare	$692.00
Rate for Payer: Cash Price	$899.60
Rate for Payer: Cash Price	$899.60
Rate for Payer: Devoted Health Medicare	$761.20
Rate for Payer: Hawaii Medical Service Association ABD	$59.38
Rate for Payer: Hawaii Medical Service Association Commercial	$77.67
Rate for Payer: Hawaii Medical Service Association Medicare	$692.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.38
Rate for Payer: Hawaii Western Management Group Commercial	$62.14
Rate for Payer: Health Management Network Commercial	$1,176.40
Rate for Payer: Humana Medicare	$692.00
Rate for Payer: Kaiser Permanente Commercial	$1,245.60
Rate for Payer: Kaiser Permanente Medicaid	$705.84
Rate for Payer: Kaiser Permanente Medicare	$692.00
Rate for Payer: MDX Hawaii PPO	$1,342.48
Rate for Payer: Ohana Health Plan Medicaid	$692.00
Rate for Payer: Ohana Health Plan Medicare	$692.00
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$692.00
Rate for Payer: University Health Alliance Commercial	$147.65

colchicine 0.6 mg tablet [HHSC]

Facility

$49.60

Service Code	NDC 00591256201
Hospital Charge Code	2500203
Hospital Revenue Code	250
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$48.11
Rate for Payer: AlohaCare Medicaid	$24.80
Rate for Payer: AlohaCare Medicare	$24.80
Rate for Payer: Cash Price	$32.24
Rate for Payer: Devoted Health Medicare	$27.28
Rate for Payer: Hawaii Medical Service Association Medicare	$24.80
Rate for Payer: Hawaii Western Management Group Commercial	$47.12
Rate for Payer: Health Management Network Commercial	$42.16
Rate for Payer: Humana Medicare	$24.80
Rate for Payer: Kaiser Permanente Commercial	$44.64
Rate for Payer: Kaiser Permanente Medicaid	$25.30
Rate for Payer: Kaiser Permanente Medicare	$24.80
Rate for Payer: MDX Hawaii PPO	$48.11
Rate for Payer: Ohana Health Plan Medicaid	$24.80
Rate for Payer: Ohana Health Plan Medicare	$24.80
Rate for Payer: UnitedHealthcare Medicaid	$29.76
Rate for Payer: UnitedHealthcare Medicare	$24.80
Rate for Payer: University Health Alliance Commercial	$36.15

colchicine 0.6 mg tablet [HHSC]

Facility

$49.60

Service Code	NDC 00591256201
Hospital Charge Code	2500203
Hospital Revenue Code	250
Min. Negotiated Rate	$42.16
Max. Negotiated Rate	$48.11
Rate for Payer: Cash Price	$32.24
Rate for Payer: Health Management Network Commercial	$42.16
Rate for Payer: Kaiser Permanente Commercial	$44.64
Rate for Payer: MDX Hawaii PPO	$48.11

colchicine 0.6 mg tablet [HHSC]

Facility

$44.74

Service Code	NDC 50268018715
Hospital Charge Code	2500203
Hospital Revenue Code	250
Min. Negotiated Rate	$38.03
Max. Negotiated Rate	$43.40
Rate for Payer: Cash Price	$29.08
Rate for Payer: Health Management Network Commercial	$38.03
Rate for Payer: Kaiser Permanente Commercial	$40.27
Rate for Payer: MDX Hawaii PPO	$43.40

colchicine 0.6 mg tablet [HHSC]

Facility

$44.74

Service Code	NDC 50268018715
Hospital Charge Code	2500203
Hospital Revenue Code	250
Min. Negotiated Rate	$22.37
Max. Negotiated Rate	$43.40
Rate for Payer: AlohaCare Medicaid	$22.37
Rate for Payer: AlohaCare Medicare	$22.37
Rate for Payer: Cash Price	$29.08
Rate for Payer: Devoted Health Medicare	$24.61
Rate for Payer: Hawaii Medical Service Association Medicare	$22.37
Rate for Payer: Hawaii Western Management Group Commercial	$42.50
Rate for Payer: Health Management Network Commercial	$38.03
Rate for Payer: Humana Medicare	$22.37
Rate for Payer: Kaiser Permanente Commercial	$40.27
Rate for Payer: Kaiser Permanente Medicaid	$22.82
Rate for Payer: Kaiser Permanente Medicare	$22.37
Rate for Payer: MDX Hawaii PPO	$43.40
Rate for Payer: Ohana Health Plan Medicaid	$22.37
Rate for Payer: Ohana Health Plan Medicare	$22.37
Rate for Payer: UnitedHealthcare Medicaid	$26.84
Rate for Payer: UnitedHealthcare Medicare	$22.37
Rate for Payer: University Health Alliance Commercial	$32.61

colchicine 0.6 mg tablet [HHSC]

Facility

$42.48

Service Code	NDC 00378108693
Hospital Charge Code	2500203
Hospital Revenue Code	250
Min. Negotiated Rate	$36.11
Max. Negotiated Rate	$41.21
Rate for Payer: Cash Price	$27.61
Rate for Payer: Health Management Network Commercial	$36.11
Rate for Payer: Kaiser Permanente Commercial	$38.23
Rate for Payer: MDX Hawaii PPO	$41.21

colchicine 0.6 mg tablet [HHSC]

Facility

$42.49

Service Code	NDC 00378108601
Hospital Charge Code	2500203
Hospital Revenue Code	250
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$41.22
Rate for Payer: AlohaCare Medicaid	$21.25
Rate for Payer: AlohaCare Medicare	$21.25
Rate for Payer: Cash Price	$27.62
Rate for Payer: Devoted Health Medicare	$23.37
Rate for Payer: Hawaii Medical Service Association Medicare	$21.25
Rate for Payer: Hawaii Western Management Group Commercial	$40.37
Rate for Payer: Health Management Network Commercial	$36.12
Rate for Payer: Humana Medicare	$21.25
Rate for Payer: Kaiser Permanente Commercial	$38.24
Rate for Payer: Kaiser Permanente Medicaid	$21.67
Rate for Payer: Kaiser Permanente Medicare	$21.25
Rate for Payer: MDX Hawaii PPO	$41.22
Rate for Payer: Ohana Health Plan Medicaid	$21.25
Rate for Payer: Ohana Health Plan Medicare	$21.25
Rate for Payer: UnitedHealthcare Medicaid	$25.49
Rate for Payer: UnitedHealthcare Medicare	$21.25
Rate for Payer: University Health Alliance Commercial	$30.97

colchicine 0.6 mg tablet [HHSC]

Facility

$42.49

Service Code	NDC 66993016502
Hospital Charge Code	2500203
Hospital Revenue Code	250
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$41.22
Rate for Payer: AlohaCare Medicaid	$21.25
Rate for Payer: AlohaCare Medicare	$21.25
Rate for Payer: Cash Price	$27.62
Rate for Payer: Devoted Health Medicare	$23.37
Rate for Payer: Hawaii Medical Service Association Medicare	$21.25
Rate for Payer: Hawaii Western Management Group Commercial	$40.37
Rate for Payer: Health Management Network Commercial	$36.12
Rate for Payer: Humana Medicare	$21.25
Rate for Payer: Kaiser Permanente Commercial	$38.24
Rate for Payer: Kaiser Permanente Medicaid	$21.67
Rate for Payer: Kaiser Permanente Medicare	$21.25
Rate for Payer: MDX Hawaii PPO	$41.22
Rate for Payer: Ohana Health Plan Medicaid	$21.25
Rate for Payer: Ohana Health Plan Medicare	$21.25
Rate for Payer: UnitedHealthcare Medicaid	$25.49
Rate for Payer: UnitedHealthcare Medicare	$21.25
Rate for Payer: University Health Alliance Commercial	$30.97

colchicine 0.6 mg tablet [HHSC]

Facility

$42.49

Service Code	NDC 00254200801
Hospital Charge Code	2500203
Hospital Revenue Code	250
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$41.22
Rate for Payer: AlohaCare Medicaid	$21.25
Rate for Payer: AlohaCare Medicare	$21.25
Rate for Payer: Cash Price	$27.62
Rate for Payer: Devoted Health Medicare	$23.37
Rate for Payer: Hawaii Medical Service Association Medicare	$21.25
Rate for Payer: Hawaii Western Management Group Commercial	$40.37
Rate for Payer: Health Management Network Commercial	$36.12
Rate for Payer: Humana Medicare	$21.25
Rate for Payer: Kaiser Permanente Commercial	$38.24
Rate for Payer: Kaiser Permanente Medicaid	$21.67
Rate for Payer: Kaiser Permanente Medicare	$21.25
Rate for Payer: MDX Hawaii PPO	$41.22
Rate for Payer: Ohana Health Plan Medicaid	$21.25
Rate for Payer: Ohana Health Plan Medicare	$21.25
Rate for Payer: UnitedHealthcare Medicaid	$25.49
Rate for Payer: UnitedHealthcare Medicare	$21.25
Rate for Payer: University Health Alliance Commercial	$30.97

colchicine 0.6 mg tablet [HHSC]

Facility

$42.49

Service Code	NDC 00254200811
Hospital Charge Code	2500203
Hospital Revenue Code	250
Min. Negotiated Rate	$36.12
Max. Negotiated Rate	$41.22
Rate for Payer: Cash Price	$27.62
Rate for Payer: Health Management Network Commercial	$36.12
Rate for Payer: Kaiser Permanente Commercial	$38.24
Rate for Payer: MDX Hawaii PPO	$41.22

colchicine 0.6 mg tablet [HHSC]

Facility

$42.49

Service Code	NDC 66993016502
Hospital Charge Code	2500203
Hospital Revenue Code	250
Min. Negotiated Rate	$36.12
Max. Negotiated Rate	$41.22
Rate for Payer: Cash Price	$27.62
Rate for Payer: Health Management Network Commercial	$36.12
Rate for Payer: Kaiser Permanente Commercial	$38.24
Rate for Payer: MDX Hawaii PPO	$41.22

colchicine 0.6 mg tablet [HHSC]

Facility

$49.29

Service Code	NDC 64764011907
Hospital Charge Code	2500203
Hospital Revenue Code	250
Min. Negotiated Rate	$24.64
Max. Negotiated Rate	$47.81
Rate for Payer: AlohaCare Medicaid	$24.64
Rate for Payer: AlohaCare Medicare	$24.64
Rate for Payer: Cash Price	$32.04
Rate for Payer: Devoted Health Medicare	$27.11
Rate for Payer: Hawaii Medical Service Association Medicare	$24.64
Rate for Payer: Hawaii Western Management Group Commercial	$46.83
Rate for Payer: Health Management Network Commercial	$41.90
Rate for Payer: Humana Medicare	$24.64
Rate for Payer: Kaiser Permanente Commercial	$44.36
Rate for Payer: Kaiser Permanente Medicaid	$25.14
Rate for Payer: Kaiser Permanente Medicare	$24.64
Rate for Payer: MDX Hawaii PPO	$47.81
Rate for Payer: Ohana Health Plan Medicaid	$24.64
Rate for Payer: Ohana Health Plan Medicare	$24.64
Rate for Payer: UnitedHealthcare Medicaid	$29.57
Rate for Payer: UnitedHealthcare Medicare	$24.64
Rate for Payer: University Health Alliance Commercial	$35.93

Know your out-of-pocket cost for care.

All Charges