Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

FLT3 GENE ANLYS TYROSINE KINASE DOMAIN VARIANTS

Facility

IP

$696.00

Service Code	HCPCS 81246
Hospital Charge Code	3108124601
Hospital Revenue Code	310
Min. Negotiated Rate	$591.60
Max. Negotiated Rate	$675.12
Rate for Payer: Cash Price	$417.60
Rate for Payer: Health Management Network Commercial	$591.60
Rate for Payer: MDX Hawaii PPO	$675.12

FLUCONAZOLE 100 MG TABLET [10044]

Facility

OP

$29.00

Service Code	NDC 50268033715
Hospital Revenue Code	637
Min. Negotiated Rate	$14.79
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$17.40
Rate for Payer: Hawaii Western Management Group Commercial	$27.55
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Kaiser Permanente Commercial	$18.27
Rate for Payer: Kaiser Permanente Medicaid	$14.79
Rate for Payer: MDX Hawaii PPO	$28.13
Rate for Payer: University Health Alliance Commercial	$21.14

FLUCONAZOLE 100 MG TABLET [10044]

Facility

OP

$27.00

Service Code	NDC 57237000430
Hospital Revenue Code	637
Min. Negotiated Rate	$13.77
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$16.20
Rate for Payer: Hawaii Western Management Group Commercial	$25.65
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Kaiser Permanente Commercial	$17.01
Rate for Payer: Kaiser Permanente Medicaid	$13.77
Rate for Payer: MDX Hawaii PPO	$26.19
Rate for Payer: University Health Alliance Commercial	$19.68

FLUCONAZOLE 100 MG TABLET [10044]

Facility

OP

$30.00

Service Code	NDC 00904650061
Hospital Revenue Code	637
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Hawaii Western Management Group Commercial	$28.50
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$15.30
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: University Health Alliance Commercial	$21.87

FLUCONAZOLE 100 MG TABLET [10044]

Facility

OP

$29.00

Service Code	NDC 50268033711
Hospital Revenue Code	637
Min. Negotiated Rate	$14.79
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$17.40
Rate for Payer: Hawaii Western Management Group Commercial	$27.55
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Kaiser Permanente Commercial	$18.27
Rate for Payer: Kaiser Permanente Medicaid	$14.79
Rate for Payer: MDX Hawaii PPO	$28.13
Rate for Payer: University Health Alliance Commercial	$21.14

FLUCONAZOLE 100 MG TABLET [10044]

Facility

IP

$29.00

Service Code	NDC 50268033711
Hospital Revenue Code	250
Min. Negotiated Rate	$24.65
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$17.40
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: MDX Hawaii PPO	$28.13

FLUCONAZOLE 100 MG TABLET [10044]

Facility

IP

$29.00

Service Code	NDC 50268033715
Hospital Revenue Code	250
Min. Negotiated Rate	$24.65
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$17.40
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: MDX Hawaii PPO	$28.13

FLUCONAZOLE 100 MG TABLET [10044]

Facility

IP

$27.00

Service Code	NDC 57237000430
Hospital Revenue Code	250
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: MDX Hawaii PPO	$26.19

FLUCONAZOLE 100 MG TABLET [10044]

Facility

IP

$30.00

Service Code	NDC 00904650061
Hospital Revenue Code	250
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: MDX Hawaii PPO	$29.10

FLUCONAZOLE 10 MG/ML ORAL SUSPENSION [14232]

Facility

OP

$90.00

Service Code	NDC 57237014935
Hospital Revenue Code	637
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$54.00
Rate for Payer: Hawaii Western Management Group Commercial	$85.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: University Health Alliance Commercial	$65.60

FLUCONAZOLE 10 MG/ML ORAL SUSPENSION [14232]

Facility

IP

$90.00

Service Code	NDC 57237014935
Hospital Revenue Code	250
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$54.00
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: MDX Hawaii PPO	$87.30

FLUCONAZOLE 150 MG TABLET [13577]

Facility

IP

$36.00

Service Code	NDC 68001025317
Hospital Revenue Code	250
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$21.60
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$34.92

FLUCONAZOLE 150 MG TABLET [13577]

Facility

OP

$36.00

Service Code	NDC 68001025344
Hospital Revenue Code	637
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$21.60
Rate for Payer: Hawaii Western Management Group Commercial	$34.20
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Kaiser Permanente Commercial	$22.68
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: University Health Alliance Commercial	$26.24

FLUCONAZOLE 150 MG TABLET [13577]

Facility

IP

$36.00

Service Code	NDC 68001025344
Hospital Revenue Code	250
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$21.60
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$34.92

FLUCONAZOLE 150 MG TABLET [13577]

Facility

OP

$36.00

Service Code	NDC 68001025317
Hospital Revenue Code	637
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$21.60
Rate for Payer: Hawaii Western Management Group Commercial	$34.20
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Kaiser Permanente Commercial	$22.68
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: University Health Alliance Commercial	$26.24

FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK [10049]

Facility

IP

$38.00

Service Code	HCPCS J1450
Hospital Revenue Code	250
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: MDX Hawaii PPO	$36.86

FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK [10049]

Facility

OP

$38.00

Service Code	HCPCS J1450
Hospital Revenue Code	636
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Cash Price	$22.80
Rate for Payer: Hawaii Medical Service Association ABD	$2.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.26
Rate for Payer: Hawaii Western Management Group Commercial	$36.10
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Kaiser Permanente Commercial	$23.94
Rate for Payer: Kaiser Permanente Medicaid	$19.38
Rate for Payer: MDX Hawaii PPO	$36.86
Rate for Payer: UnitedHealthcare Medicaid	$22.80
Rate for Payer: University Health Alliance Commercial	$27.70

FLUCONAZOLE 200 MG TABLET [10045]

Facility

OP

$110.00

Service Code	NDC 68084073511
Hospital Revenue Code	637
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$66.00
Rate for Payer: Hawaii Western Management Group Commercial	$104.50
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: Kaiser Permanente Medicaid	$56.10
Rate for Payer: MDX Hawaii PPO	$106.70
Rate for Payer: University Health Alliance Commercial	$80.18

FLUCONAZOLE 200 MG TABLET [10045]

Facility

IP

$110.00

Service Code	NDC 68084073511
Hospital Revenue Code	250
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$66.00
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: MDX Hawaii PPO	$106.70

FLUCONAZOLE 200 MG TABLET [10045]

Facility

OP

$110.00

Service Code	NDC 68084073501
Hospital Revenue Code	637
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$66.00
Rate for Payer: Hawaii Western Management Group Commercial	$104.50
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: Kaiser Permanente Medicaid	$56.10
Rate for Payer: MDX Hawaii PPO	$106.70
Rate for Payer: University Health Alliance Commercial	$80.18

FLUCONAZOLE 200 MG TABLET [10045]

Facility

IP

$110.00

Service Code	NDC 68084073501
Hospital Revenue Code	250
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$66.00
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: MDX Hawaii PPO	$106.70

FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK [10050]

Facility

OP

$59.00

Service Code	HCPCS J1450
Hospital Revenue Code	636
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$57.23
Rate for Payer: Cash Price	$35.40
Rate for Payer: Cash Price	$35.40
Rate for Payer: Hawaii Medical Service Association ABD	$2.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.26
Rate for Payer: Hawaii Western Management Group Commercial	$56.05
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: Kaiser Permanente Commercial	$37.17
Rate for Payer: Kaiser Permanente Medicaid	$30.09
Rate for Payer: MDX Hawaii PPO	$57.23
Rate for Payer: UnitedHealthcare Medicaid	$35.40
Rate for Payer: University Health Alliance Commercial	$43.01

FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK [10050]

Facility

IP

$59.00

Service Code	HCPCS J1450
Hospital Revenue Code	250
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$57.23
Rate for Payer: Cash Price	$35.40
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: MDX Hawaii PPO	$57.23

FLUCONAZOLE 40 MG/ML ORAL SUSPENSION [14233]

Facility

IP

$196.00

Service Code	NDC 57237015035
Hospital Revenue Code	250
Min. Negotiated Rate	$166.60
Max. Negotiated Rate	$190.12
Rate for Payer: Cash Price	$117.60
Rate for Payer: Health Management Network Commercial	$166.60
Rate for Payer: MDX Hawaii PPO	$190.12

FLUCONAZOLE 40 MG/ML ORAL SUSPENSION [14233]

Facility

OP

$195.00

Service Code	NDC 70436022748
Hospital Revenue Code	637
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$189.15
Rate for Payer: Cash Price	$117.00
Rate for Payer: Hawaii Western Management Group Commercial	$185.25
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Kaiser Permanente Commercial	$122.85
Rate for Payer: Kaiser Permanente Medicaid	$99.45
Rate for Payer: MDX Hawaii PPO	$189.15
Rate for Payer: University Health Alliance Commercial	$142.14

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