Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

FLUCONAZOLE 40 MG/ML ORAL SUSPENSION [14233]

Facility

OP

$195.00

Service Code	NDC 70436022748
Hospital Revenue Code	637
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$189.15
Rate for Payer: AlohaCare Medicaid	$97.50
Rate for Payer: AlohaCare Medicare	$148.20
Rate for Payer: Cash Price	$117.00
Rate for Payer: Devoted Health Medicare	$163.80
Rate for Payer: Hawaii Medical Service Association Medicare	$148.20
Rate for Payer: Hawaii Western Management Group Commercial	$185.25
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Humana Medicare	$148.20
Rate for Payer: Kaiser Permanente Commercial	$175.50
Rate for Payer: Kaiser Permanente Medicaid	$99.45
Rate for Payer: Kaiser Permanente Medicare	$148.20
Rate for Payer: MDX Hawaii PPO	$189.15
Rate for Payer: Ohana Health Plan Medicaid	$148.20
Rate for Payer: Ohana Health Plan Medicare	$148.20
Rate for Payer: UnitedHealthcare Medicare	$148.20
Rate for Payer: University Health Alliance Commercial	$142.14

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: Kaiser Permanente Commercial	$176.40
Rate for Payer: MDX Hawaii PPO	$190.12

FLUCONAZOLE 40 MG/ML ORAL SUSPENSION [14233]

Facility

IP

$195.00

Service Code	NDC 70436022748
Hospital Revenue Code	250
Min. Negotiated Rate	$165.75
Max. Negotiated Rate	$189.15
Rate for Payer: Cash Price	$117.00
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Kaiser Permanente Commercial	$175.50
Rate for Payer: MDX Hawaii PPO	$189.15

FLUCONAZOLE 40 MG/ML ORAL SUSPENSION [14233]

Facility

OP

$196.00

Service Code	NDC 57237015035
Hospital Revenue Code	637
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$190.12
Rate for Payer: AlohaCare Medicaid	$98.00
Rate for Payer: AlohaCare Medicare	$148.96
Rate for Payer: Cash Price	$117.60
Rate for Payer: Devoted Health Medicare	$164.64
Rate for Payer: Hawaii Medical Service Association Medicare	$148.96
Rate for Payer: Hawaii Western Management Group Commercial	$186.20
Rate for Payer: Health Management Network Commercial	$166.60
Rate for Payer: Humana Medicare	$148.96
Rate for Payer: Kaiser Permanente Commercial	$176.40
Rate for Payer: Kaiser Permanente Medicaid	$99.96
Rate for Payer: Kaiser Permanente Medicare	$148.96
Rate for Payer: MDX Hawaii PPO	$190.12
Rate for Payer: Ohana Health Plan Medicaid	$148.96
Rate for Payer: Ohana Health Plan Medicare	$148.96
Rate for Payer: UnitedHealthcare Medicare	$148.96
Rate for Payer: University Health Alliance Commercial	$142.86

FLUCYTOSINE 500 MG CAPSULE [10052]

Facility

OP

$283.00

Service Code	NDC 60687061021
Hospital Revenue Code	637
Min. Negotiated Rate	$141.50
Max. Negotiated Rate	$274.51
Rate for Payer: AlohaCare Medicaid	$141.50
Rate for Payer: AlohaCare Medicare	$215.08
Rate for Payer: Cash Price	$169.80
Rate for Payer: Devoted Health Medicare	$237.72
Rate for Payer: Hawaii Medical Service Association Medicare	$215.08
Rate for Payer: Hawaii Western Management Group Commercial	$268.85
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Humana Medicare	$215.08
Rate for Payer: Kaiser Permanente Commercial	$254.70
Rate for Payer: Kaiser Permanente Medicaid	$144.33
Rate for Payer: Kaiser Permanente Medicare	$215.08
Rate for Payer: MDX Hawaii PPO	$274.51
Rate for Payer: Ohana Health Plan Medicaid	$215.08
Rate for Payer: Ohana Health Plan Medicare	$215.08
Rate for Payer: UnitedHealthcare Medicare	$215.08
Rate for Payer: University Health Alliance Commercial	$206.28

FLUCYTOSINE 500 MG CAPSULE [10052]

Facility

OP

$229.00

Service Code	NDC 00904683507
Hospital Revenue Code	637
Min. Negotiated Rate	$114.50
Max. Negotiated Rate	$222.13
Rate for Payer: AlohaCare Medicaid	$114.50
Rate for Payer: AlohaCare Medicare	$174.04
Rate for Payer: Cash Price	$137.40
Rate for Payer: Devoted Health Medicare	$192.36
Rate for Payer: Hawaii Medical Service Association Medicare	$174.04
Rate for Payer: Hawaii Western Management Group Commercial	$217.55
Rate for Payer: Health Management Network Commercial	$194.65
Rate for Payer: Humana Medicare	$174.04
Rate for Payer: Kaiser Permanente Commercial	$206.10
Rate for Payer: Kaiser Permanente Medicaid	$116.79
Rate for Payer: Kaiser Permanente Medicare	$174.04
Rate for Payer: MDX Hawaii PPO	$222.13
Rate for Payer: Ohana Health Plan Medicaid	$174.04
Rate for Payer: Ohana Health Plan Medicare	$174.04
Rate for Payer: UnitedHealthcare Medicare	$174.04
Rate for Payer: University Health Alliance Commercial	$166.92

FLUCYTOSINE 500 MG CAPSULE [10052]

Facility

IP

$283.00

Service Code	NDC 60687061021
Hospital Revenue Code	250
Min. Negotiated Rate	$240.55
Max. Negotiated Rate	$274.51
Rate for Payer: Cash Price	$169.80
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Kaiser Permanente Commercial	$254.70
Rate for Payer: MDX Hawaii PPO	$274.51

FLUCYTOSINE 500 MG CAPSULE [10052]

Facility

IP

$283.00

Service Code	NDC 60687061011
Hospital Revenue Code	250
Min. Negotiated Rate	$240.55
Max. Negotiated Rate	$274.51
Rate for Payer: Cash Price	$169.80
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Kaiser Permanente Commercial	$254.70
Rate for Payer: MDX Hawaii PPO	$274.51

FLUCYTOSINE 500 MG CAPSULE [10052]

Facility

IP

$229.00

Service Code	NDC 00904683507
Hospital Revenue Code	250
Min. Negotiated Rate	$194.65
Max. Negotiated Rate	$222.13
Rate for Payer: Cash Price	$137.40
Rate for Payer: Health Management Network Commercial	$194.65
Rate for Payer: Kaiser Permanente Commercial	$206.10
Rate for Payer: MDX Hawaii PPO	$222.13

FLUCYTOSINE 500 MG CAPSULE [10052]

Facility

OP

$283.00

Service Code	NDC 60687061011
Hospital Revenue Code	637
Min. Negotiated Rate	$141.50
Max. Negotiated Rate	$274.51
Rate for Payer: AlohaCare Medicaid	$141.50
Rate for Payer: AlohaCare Medicare	$215.08
Rate for Payer: Cash Price	$169.80
Rate for Payer: Devoted Health Medicare	$237.72
Rate for Payer: Hawaii Medical Service Association Medicare	$215.08
Rate for Payer: Hawaii Western Management Group Commercial	$268.85
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Humana Medicare	$215.08
Rate for Payer: Kaiser Permanente Commercial	$254.70
Rate for Payer: Kaiser Permanente Medicaid	$144.33
Rate for Payer: Kaiser Permanente Medicare	$215.08
Rate for Payer: MDX Hawaii PPO	$274.51
Rate for Payer: Ohana Health Plan Medicaid	$215.08
Rate for Payer: Ohana Health Plan Medicare	$215.08
Rate for Payer: UnitedHealthcare Medicare	$215.08
Rate for Payer: University Health Alliance Commercial	$206.28

FLUDROCORTISONE 0.1 MG TABLET [10054]

Facility

IP

$4.00

Service Code	NDC 68084028801
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

FLUDROCORTISONE 0.1 MG TABLET [10054]

Facility

OP

$4.00

Service Code	NDC 68084028801
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$3.04
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3.04
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$3.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$3.04
Rate for Payer: Ohana Health Plan Medicare	$3.04
Rate for Payer: UnitedHealthcare Medicare	$3.04
Rate for Payer: University Health Alliance Commercial	$2.92

FLUDROCORTISONE 0.1 MG TABLET [10054]

Facility

OP

$6.00

Service Code	NDC 50268033015
Hospital Revenue Code	637
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$4.56
Rate for Payer: Cash Price	$3.60
Rate for Payer: Devoted Health Medicare	$5.04
Rate for Payer: Hawaii Medical Service Association Medicare	$4.56
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$4.56
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$4.56
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$4.56
Rate for Payer: Ohana Health Plan Medicare	$4.56
Rate for Payer: UnitedHealthcare Medicare	$4.56
Rate for Payer: University Health Alliance Commercial	$4.37

FLUDROCORTISONE 0.1 MG TABLET [10054]

Facility

OP

$6.00

Service Code	NDC 50268033011
Hospital Revenue Code	637
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$4.56
Rate for Payer: Cash Price	$3.60
Rate for Payer: Devoted Health Medicare	$5.04
Rate for Payer: Hawaii Medical Service Association Medicare	$4.56
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$4.56
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$4.56
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$4.56
Rate for Payer: Ohana Health Plan Medicare	$4.56
Rate for Payer: UnitedHealthcare Medicare	$4.56
Rate for Payer: University Health Alliance Commercial	$4.37

FLUDROCORTISONE 0.1 MG TABLET [10054]

Facility

IP

$6.00

Service Code	NDC 50268033015
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

FLUDROCORTISONE 0.1 MG TABLET [10054]

Facility

IP

$6.00

Service Code	NDC 50268033011
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [39744]

Facility

IP

$29.00

Service Code	NDC 00143978401
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: Kaiser Permanente Commercial	$26.10
Rate for Payer: MDX Hawaii PPO	$28.13

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [39744]

Facility

IP

$28.00

Service Code	NDC 00143968401
Hospital Revenue Code	250
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$16.80
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: MDX Hawaii PPO	$27.16

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [39744]

Facility

IP

$29.00

Service Code	NDC 00143978410
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: Kaiser Permanente Commercial	$26.10
Rate for Payer: MDX Hawaii PPO	$28.13

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [39744]

Facility

IP

$28.00

Service Code	NDC 00143968410
Hospital Revenue Code	250
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$16.80
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: MDX Hawaii PPO	$27.16

FLUORESCEIN 1 MG EYE STRIPS [27663]

Facility

OP

$1.00

Service Code	NDC 17238090030
Hospital Revenue Code	637
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.76
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.76
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.76
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.76
Rate for Payer: Ohana Health Plan Medicare	$0.76
Rate for Payer: UnitedHealthcare Medicare	$0.76
Rate for Payer: University Health Alliance Commercial	$0.73

FLUORESCEIN 1 MG EYE STRIPS [27663]

Facility

OP

$1.00

Service Code	NDC 17238090099
Hospital Revenue Code	637
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.76
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.76
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.76
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.76
Rate for Payer: Ohana Health Plan Medicare	$0.76
Rate for Payer: UnitedHealthcare Medicare	$0.76
Rate for Payer: University Health Alliance Commercial	$0.73

FLUORESCEIN 1 MG EYE STRIPS [27663]

Facility

IP

$1.00

Service Code	NDC 17238090099
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

FLUORESCEIN 1 MG EYE STRIPS [27663]

Facility

OP

$1.00

Service Code	NDC 17238090011
Hospital Revenue Code	637
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.76
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.76
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.76
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.76
Rate for Payer: Ohana Health Plan Medicare	$0.76
Rate for Payer: UnitedHealthcare Medicare	$0.76
Rate for Payer: University Health Alliance Commercial	$0.73

FLUORESCEIN 1 MG EYE STRIPS [27663]

Facility

IP

$1.00

Service Code	NDC 17238090030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

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