Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

colchicine 0.6 mg tablet [HHSC]

Facility

$42.49

Service Code	NDC 00378108601
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	$41.90
Max. Negotiated Rate	$47.81
Rate for Payer: Cash Price	$32.04
Rate for Payer: Health Management Network Commercial	$41.90
Rate for Payer: Kaiser Permanente Commercial	$44.36
Rate for Payer: MDX Hawaii PPO	$47.81

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

$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

$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

$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

$42.48

Service Code	NDC 00378108693
Hospital Charge Code	2500203
Hospital Revenue Code	250
Min. Negotiated Rate	$21.24
Max. Negotiated Rate	$41.21
Rate for Payer: AlohaCare Medicaid	$21.24
Rate for Payer: AlohaCare Medicare	$21.24
Rate for Payer: Cash Price	$27.61
Rate for Payer: Devoted Health Medicare	$23.36
Rate for Payer: Hawaii Medical Service Association Medicare	$21.24
Rate for Payer: Hawaii Western Management Group Commercial	$40.36
Rate for Payer: Health Management Network Commercial	$36.11
Rate for Payer: Humana Medicare	$21.24
Rate for Payer: Kaiser Permanente Commercial	$38.23
Rate for Payer: Kaiser Permanente Medicaid	$21.66
Rate for Payer: Kaiser Permanente Medicare	$21.24
Rate for Payer: MDX Hawaii PPO	$41.21
Rate for Payer: Ohana Health Plan Medicaid	$21.24
Rate for Payer: Ohana Health Plan Medicare	$21.24
Rate for Payer: UnitedHealthcare Medicaid	$25.49
Rate for Payer: UnitedHealthcare Medicare	$21.24
Rate for Payer: University Health Alliance Commercial	$30.96

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

$64.76

Service Code	NDC 60687038921
Hospital Charge Code	2500203
Hospital Revenue Code	250
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$62.82
Rate for Payer: AlohaCare Medicaid	$32.38
Rate for Payer: AlohaCare Medicare	$32.38
Rate for Payer: Cash Price	$42.09
Rate for Payer: Devoted Health Medicare	$35.62
Rate for Payer: Hawaii Medical Service Association Medicare	$32.38
Rate for Payer: Hawaii Western Management Group Commercial	$61.52
Rate for Payer: Health Management Network Commercial	$55.05
Rate for Payer: Humana Medicare	$32.38
Rate for Payer: Kaiser Permanente Commercial	$58.28
Rate for Payer: Kaiser Permanente Medicaid	$33.03
Rate for Payer: Kaiser Permanente Medicare	$32.38
Rate for Payer: MDX Hawaii PPO	$62.82
Rate for Payer: Ohana Health Plan Medicaid	$32.38
Rate for Payer: Ohana Health Plan Medicare	$32.38
Rate for Payer: UnitedHealthcare Medicaid	$38.86
Rate for Payer: UnitedHealthcare Medicare	$32.38
Rate for Payer: University Health Alliance Commercial	$47.20

colchicine 0.6 mg tablet [HHSC]

Facility

$64.76

Service Code	NDC 60687038921
Hospital Charge Code	2500203
Hospital Revenue Code	250
Min. Negotiated Rate	$55.05
Max. Negotiated Rate	$62.82
Rate for Payer: Cash Price	$42.09
Rate for Payer: Health Management Network Commercial	$55.05
Rate for Payer: Kaiser Permanente Commercial	$58.28
Rate for Payer: MDX Hawaii PPO	$62.82

colchicine 0.6 mg tablet [HHSC]

Facility

$42.49

Service Code	NDC 00254200801
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

collagenase 250 units/g oint 30gm [HHSC]

Facility

$1,000.29

Service Code	NDC 50484001030
Hospital Charge Code	2500204
Hospital Revenue Code	250
Min. Negotiated Rate	$500.14
Max. Negotiated Rate	$970.28
Rate for Payer: AlohaCare Medicaid	$500.14
Rate for Payer: AlohaCare Medicare	$500.14
Rate for Payer: Cash Price	$650.19
Rate for Payer: Devoted Health Medicare	$550.16
Rate for Payer: Hawaii Medical Service Association Medicare	$500.14
Rate for Payer: Hawaii Western Management Group Commercial	$950.28
Rate for Payer: Health Management Network Commercial	$850.25
Rate for Payer: Humana Medicare	$500.14
Rate for Payer: Kaiser Permanente Commercial	$900.26
Rate for Payer: Kaiser Permanente Medicaid	$510.15
Rate for Payer: Kaiser Permanente Medicare	$500.14
Rate for Payer: MDX Hawaii PPO	$970.28
Rate for Payer: Ohana Health Plan Medicaid	$500.14
Rate for Payer: Ohana Health Plan Medicare	$500.14
Rate for Payer: UnitedHealthcare Medicaid	$600.17
Rate for Payer: UnitedHealthcare Medicare	$500.14
Rate for Payer: University Health Alliance Commercial	$729.11

collagenase 250 units/g oint 30gm [HHSC]

Facility

$1,000.29

Service Code	NDC 50484001030
Hospital Charge Code	2500204
Hospital Revenue Code	250
Min. Negotiated Rate	$850.25
Max. Negotiated Rate	$970.28
Rate for Payer: Cash Price	$650.19
Rate for Payer: Health Management Network Commercial	$850.25
Rate for Payer: Kaiser Permanente Commercial	$900.26
Rate for Payer: MDX Hawaii PPO	$970.28

Collagen Cross-Linked FSI

Facility

$214.00

Service Code	HCPCS 82523
Hospital Charge Code	10288172
Hospital Revenue Code	301
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$207.58
Rate for Payer: AlohaCare Medicaid	$107.00
Rate for Payer: AlohaCare Medicare	$107.00
Rate for Payer: Cash Price	$139.10
Rate for Payer: Cash Price	$139.10
Rate for Payer: Devoted Health Medicare	$117.70
Rate for Payer: Hawaii Medical Service Association ABD	$25.83
Rate for Payer: Hawaii Medical Service Association Commercial	$23.35
Rate for Payer: Hawaii Medical Service Association Medicare	$107.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.12
Rate for Payer: Hawaii Western Management Group Commercial	$18.68
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Humana Medicare	$107.00
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: Kaiser Permanente Medicaid	$109.14
Rate for Payer: Kaiser Permanente Medicare	$107.00
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: Ohana Health Plan Medicaid	$107.00
Rate for Payer: Ohana Health Plan Medicare	$107.00
Rate for Payer: UnitedHealthcare Medicaid	$25.83
Rate for Payer: UnitedHealthcare Medicare	$107.00
Rate for Payer: University Health Alliance Commercial	$48.30

Collagen Cross-Linked FSI

Facility

$214.00

Service Code	HCPCS 82523
Hospital Charge Code	10288172
Hospital Revenue Code	301
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$139.10
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: MDX Hawaii PPO	$207.58

COLLAR CERVICAL LGE

Facility

$23.00

Service Code	HCPCS L0120
Hospital Charge Code	8266530
Hospital Revenue Code	274
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$14.95
Rate for Payer: Hawaii Western Management Group Commercial	$16.10
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: University Health Alliance Commercial	$12.88

COLLAR CERVICAL LGE

Facility

$23.00

Service Code	HCPCS L0120
Hospital Charge Code	8266530
Hospital Revenue Code	274
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$23.71
Rate for Payer: AlohaCare Medicaid	$11.50
Rate for Payer: AlohaCare Medicare	$11.50
Rate for Payer: Cash Price	$14.95
Rate for Payer: Cash Price	$14.95
Rate for Payer: Devoted Health Medicare	$12.65
Rate for Payer: Hawaii Medical Service Association Medicare	$11.50
Rate for Payer: Hawaii Western Management Group Commercial	$16.10
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Humana Medicare	$11.50
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: Kaiser Permanente Medicare	$11.50
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: Ohana Health Plan Medicaid	$11.50
Rate for Payer: Ohana Health Plan Medicare	$11.50
Rate for Payer: UnitedHealthcare Medicaid	$23.71
Rate for Payer: UnitedHealthcare Medicare	$11.50
Rate for Payer: University Health Alliance Commercial	$12.88

COLLAR CERVICAL MEDIUM

Facility

$22.00

Service Code	HCPCS L0120
Hospital Charge Code	8266517
Hospital Revenue Code	274
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$14.30
Rate for Payer: Hawaii Western Management Group Commercial	$15.40
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: University Health Alliance Commercial	$12.32

COLLAR CERVICAL MEDIUM

Facility

$22.00

Service Code	HCPCS L0120
Hospital Charge Code	8266517
Hospital Revenue Code	274
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$23.71
Rate for Payer: AlohaCare Medicaid	$11.00
Rate for Payer: AlohaCare Medicare	$11.00
Rate for Payer: Cash Price	$14.30
Rate for Payer: Cash Price	$14.30
Rate for Payer: Devoted Health Medicare	$12.10
Rate for Payer: Hawaii Medical Service Association Medicare	$11.00
Rate for Payer: Hawaii Western Management Group Commercial	$15.40
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Humana Medicare	$11.00
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: Kaiser Permanente Medicaid	$11.22
Rate for Payer: Kaiser Permanente Medicare	$11.00
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: Ohana Health Plan Medicaid	$11.00
Rate for Payer: Ohana Health Plan Medicare	$11.00
Rate for Payer: UnitedHealthcare Medicaid	$23.71
Rate for Payer: UnitedHealthcare Medicare	$11.00
Rate for Payer: University Health Alliance Commercial	$12.32

COLLAR CERVICAL SML

Facility

$23.00

Service Code	HCPCS L0120
Hospital Charge Code	8266529
Hospital Revenue Code	274
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$23.71
Rate for Payer: AlohaCare Medicaid	$11.50
Rate for Payer: AlohaCare Medicare	$11.50
Rate for Payer: Cash Price	$14.95
Rate for Payer: Cash Price	$14.95
Rate for Payer: Devoted Health Medicare	$12.65
Rate for Payer: Hawaii Medical Service Association Medicare	$11.50
Rate for Payer: Hawaii Western Management Group Commercial	$16.10
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Humana Medicare	$11.50
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: Kaiser Permanente Medicare	$11.50
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: Ohana Health Plan Medicaid	$11.50
Rate for Payer: Ohana Health Plan Medicare	$11.50
Rate for Payer: UnitedHealthcare Medicaid	$23.71
Rate for Payer: UnitedHealthcare Medicare	$11.50
Rate for Payer: University Health Alliance Commercial	$12.88

COLLAR CERVICAL SML

Facility

$23.00

Service Code	HCPCS L0120
Hospital Charge Code	8266529
Hospital Revenue Code	274
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$14.95
Rate for Payer: Hawaii Western Management Group Commercial	$16.10
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: University Health Alliance Commercial	$12.88

COLLAR EXTRICATION ADULT SHORT

Facility

$46.00

Hospital Charge Code	8266518
Hospital Revenue Code	274
Min. Negotiated Rate	$23.00
Max. Negotiated Rate	$44.62
Rate for Payer: AlohaCare Medicaid	$23.00
Rate for Payer: AlohaCare Medicare	$23.00
Rate for Payer: Cash Price	$29.90
Rate for Payer: Devoted Health Medicare	$25.30
Rate for Payer: Hawaii Medical Service Association Medicare	$23.00
Rate for Payer: Hawaii Western Management Group Commercial	$32.20
Rate for Payer: Health Management Network Commercial	$39.10
Rate for Payer: Humana Medicare	$23.00
Rate for Payer: Kaiser Permanente Commercial	$41.40
Rate for Payer: Kaiser Permanente Medicaid	$23.46
Rate for Payer: Kaiser Permanente Medicare	$23.00
Rate for Payer: MDX Hawaii PPO	$44.62
Rate for Payer: Ohana Health Plan Medicaid	$23.00
Rate for Payer: Ohana Health Plan Medicare	$23.00
Rate for Payer: UnitedHealthcare Medicare	$23.00
Rate for Payer: University Health Alliance Commercial	$25.76

COLLAR EXTRICATION ADULT SHORT

Facility

$46.00

Hospital Charge Code	8266518
Hospital Revenue Code	274
Min. Negotiated Rate	$25.76
Max. Negotiated Rate	$44.62
Rate for Payer: Cash Price	$29.90
Rate for Payer: Hawaii Western Management Group Commercial	$32.20
Rate for Payer: Health Management Network Commercial	$39.10
Rate for Payer: Kaiser Permanente Commercial	$41.40
Rate for Payer: MDX Hawaii PPO	$44.62
Rate for Payer: University Health Alliance Commercial	$25.76

COLLAR EXTRICATION PEDIATRIC

Facility

$48.00

Hospital Charge Code	8266519
Hospital Revenue Code	274
Min. Negotiated Rate	$26.88
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$31.20
Rate for Payer: Hawaii Western Management Group Commercial	$33.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: University Health Alliance Commercial	$26.88

COLLAR EXTRICATION PEDIATRIC

Facility

$48.00

Hospital Charge Code	8266519
Hospital Revenue Code	274
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$46.56
Rate for Payer: AlohaCare Medicaid	$24.00
Rate for Payer: AlohaCare Medicare	$24.00
Rate for Payer: Cash Price	$31.20
Rate for Payer: Devoted Health Medicare	$26.40
Rate for Payer: Hawaii Medical Service Association Medicare	$24.00
Rate for Payer: Hawaii Western Management Group Commercial	$33.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Humana Medicare	$24.00
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: Kaiser Permanente Medicare	$24.00
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: Ohana Health Plan Medicaid	$24.00
Rate for Payer: Ohana Health Plan Medicare	$24.00
Rate for Payer: UnitedHealthcare Medicare	$24.00
Rate for Payer: University Health Alliance Commercial	$26.88

Know your out-of-pocket cost for care.

All Charges