Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

FLEXIBLE NDSC EVAL SWLNG&LARYN SENS C/V REC

Professional

Both

$825.00

Service Code	HCPCS 92616
Hospital Revenue Code	440
Min. Negotiated Rate	$81.09
Max. Negotiated Rate	$701.25
Rate for Payer: AlohaCare Medicaid	$101.55
Rate for Payer: AlohaCare Medicare	$81.09
Rate for Payer: Cash Price	$536.25
Rate for Payer: Cash Price	$536.25
Rate for Payer: Devoted Health Medicare	$81.09
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$101.55
Rate for Payer: Hawaii Medical Service Association Medicare	$81.09
Rate for Payer: Hawaii Western Management Group Commercial	$234.93
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: Kaiser Permanente Commercial	$97.31
Rate for Payer: Kaiser Permanente Medicaid	$97.31
Rate for Payer: Kaiser Permanente Medicare	$97.31
Rate for Payer: Ohana Health Plan Medicaid	$101.55
Rate for Payer: Ohana Health Plan Medicare	$81.09
Rate for Payer: UnitedHealthcare Medicaid	$101.55
Rate for Payer: UnitedHealthcare Medicare	$81.09
Rate for Payer: University Health Alliance Commercial	$120.50

fluconazole 150 mg Tab [KMC]

Facility

$56.04

Service Code	NDC 68462010340
Hospital Revenue Code	250
Min. Negotiated Rate	$47.63
Max. Negotiated Rate	$54.36
Rate for Payer: Cash Price	$36.43
Rate for Payer: Health Management Network Commercial	$47.63
Rate for Payer: Kaiser Permanente Commercial	$50.44
Rate for Payer: MDX Hawaii PPO	$54.36

fluconazole 150 mg Tab [KMC]

Facility

$56.04

Service Code	NDC 68462010340
Hospital Revenue Code	250
Min. Negotiated Rate	$23.54
Max. Negotiated Rate	$54.36
Rate for Payer: AlohaCare Medicaid	$28.02
Rate for Payer: AlohaCare Medicare	$23.54
Rate for Payer: Cash Price	$36.43
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$51.56
Rate for Payer: Devoted Health Medicare	$23.54
Rate for Payer: Hawaii Medical Service Association Medicare	$23.54
Rate for Payer: Hawaii Western Management Group Commercial	$53.24
Rate for Payer: Health Management Network Commercial	$47.63
Rate for Payer: Humana Medicare	$23.54
Rate for Payer: Kaiser Permanente Commercial	$50.44
Rate for Payer: Kaiser Permanente Medicaid	$28.58
Rate for Payer: Kaiser Permanente Medicare	$23.54
Rate for Payer: MDX Hawaii PPO	$54.36
Rate for Payer: Ohana Health Plan Medicaid	$23.54
Rate for Payer: Ohana Health Plan Medicare	$23.54
Rate for Payer: UnitedHealthcare Medicaid	$33.62
Rate for Payer: UnitedHealthcare Medicare	$23.54
Rate for Payer: University Health Alliance Commercial	$40.85

fluconazole 200 mg/100 mL IV Sol [KMC]

Facility

$0.19

Service Code	HCPCS J1450
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.12
Rate for Payer: Health Management Network Commercial	$0.16
Rate for Payer: Kaiser Permanente Commercial	$0.17
Rate for Payer: MDX Hawaii PPO	$0.18

fluconazole 200 mg/100 mL IV Sol [KMC]

Facility

$0.19

Service Code	HCPCS J1450
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$2.26
Rate for Payer: AlohaCare Medicaid	$0.10
Rate for Payer: AlohaCare Medicare	$0.08
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cash Price	$0.12
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.17
Rate for Payer: Devoted Health Medicare	$0.08
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$2.26
Rate for Payer: Hawaii Medical Service Association Medicare	$0.08
Rate for Payer: Hawaii Western Management Group Commercial	$0.18
Rate for Payer: Health Management Network Commercial	$0.16
Rate for Payer: Humana Medicare	$0.08
Rate for Payer: Kaiser Permanente Commercial	$0.17
Rate for Payer: Kaiser Permanente Medicaid	$0.10
Rate for Payer: Kaiser Permanente Medicare	$0.08
Rate for Payer: MDX Hawaii PPO	$0.18
Rate for Payer: Ohana Health Plan Medicaid	$0.08
Rate for Payer: Ohana Health Plan Medicare	$0.08
Rate for Payer: UnitedHealthcare Medicaid	$0.11
Rate for Payer: UnitedHealthcare Medicare	$0.08
Rate for Payer: University Health Alliance Commercial	$0.14

fluconazole 200 mg / 5 mL REC Susp [KMC]

Facility

$14.80

Service Code	NDC 16714069601
Hospital Revenue Code	250
Min. Negotiated Rate	$12.58
Max. Negotiated Rate	$14.36
Rate for Payer: Cash Price	$9.62
Rate for Payer: Health Management Network Commercial	$12.58
Rate for Payer: Kaiser Permanente Commercial	$13.32
Rate for Payer: MDX Hawaii PPO	$14.36

fluconazole 200 mg / 5 mL REC Susp [KMC]

Facility

$14.80

Service Code	NDC 16714069601
Hospital Revenue Code	250
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$14.36
Rate for Payer: AlohaCare Medicaid	$7.40
Rate for Payer: AlohaCare Medicare	$6.22
Rate for Payer: Cash Price	$9.62
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$13.62
Rate for Payer: Devoted Health Medicare	$6.22
Rate for Payer: Hawaii Medical Service Association Medicare	$6.22
Rate for Payer: Hawaii Western Management Group Commercial	$14.06
Rate for Payer: Health Management Network Commercial	$12.58
Rate for Payer: Humana Medicare	$6.22
Rate for Payer: Kaiser Permanente Commercial	$13.32
Rate for Payer: Kaiser Permanente Medicaid	$7.55
Rate for Payer: Kaiser Permanente Medicare	$6.22
Rate for Payer: MDX Hawaii PPO	$14.36
Rate for Payer: Ohana Health Plan Medicaid	$6.22
Rate for Payer: Ohana Health Plan Medicare	$6.22
Rate for Payer: UnitedHealthcare Medicaid	$8.88
Rate for Payer: UnitedHealthcare Medicare	$6.22
Rate for Payer: University Health Alliance Commercial	$10.79

fluconazole 200 mg Tab [KMC]

Facility

$57.62

Service Code	NDC 68462010430
Hospital Revenue Code	250
Min. Negotiated Rate	$48.98
Max. Negotiated Rate	$55.89
Rate for Payer: Cash Price	$37.45
Rate for Payer: Health Management Network Commercial	$48.98
Rate for Payer: Kaiser Permanente Commercial	$51.86
Rate for Payer: MDX Hawaii PPO	$55.89

fluconazole 200 mg Tab [KMC]

Facility

$57.62

Service Code	NDC 68462010430
Hospital Revenue Code	250
Min. Negotiated Rate	$24.20
Max. Negotiated Rate	$55.89
Rate for Payer: AlohaCare Medicaid	$28.81
Rate for Payer: AlohaCare Medicare	$24.20
Rate for Payer: Cash Price	$37.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$53.01
Rate for Payer: Devoted Health Medicare	$24.20
Rate for Payer: Hawaii Medical Service Association Medicare	$24.20
Rate for Payer: Hawaii Western Management Group Commercial	$54.74
Rate for Payer: Health Management Network Commercial	$48.98
Rate for Payer: Humana Medicare	$24.20
Rate for Payer: Kaiser Permanente Commercial	$51.86
Rate for Payer: Kaiser Permanente Medicaid	$29.39
Rate for Payer: Kaiser Permanente Medicare	$24.20
Rate for Payer: MDX Hawaii PPO	$55.89
Rate for Payer: Ohana Health Plan Medicaid	$24.20
Rate for Payer: Ohana Health Plan Medicare	$24.20
Rate for Payer: UnitedHealthcare Medicaid	$34.57
Rate for Payer: UnitedHealthcare Medicare	$24.20
Rate for Payer: University Health Alliance Commercial	$42.00

fluconazole 400 mg / 200 mL NS bag [KMC]

Facility

$0.34

Service Code	HCPCS J1450
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.33
Rate for Payer: Cash Price	$0.22
Rate for Payer: Health Management Network Commercial	$0.29
Rate for Payer: Kaiser Permanente Commercial	$0.31
Rate for Payer: MDX Hawaii PPO	$0.33

fluconazole 400 mg / 200 mL NS bag [KMC]

Facility

$0.34

Service Code	HCPCS J1450
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.26
Rate for Payer: AlohaCare Medicaid	$0.17
Rate for Payer: AlohaCare Medicare	$0.14
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cash Price	$0.22
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.31
Rate for Payer: Devoted Health Medicare	$0.14
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$2.26
Rate for Payer: Hawaii Medical Service Association Medicare	$0.14
Rate for Payer: Hawaii Western Management Group Commercial	$0.32
Rate for Payer: Health Management Network Commercial	$0.29
Rate for Payer: Humana Medicare	$0.14
Rate for Payer: Kaiser Permanente Commercial	$0.31
Rate for Payer: Kaiser Permanente Medicaid	$0.17
Rate for Payer: Kaiser Permanente Medicare	$0.14
Rate for Payer: MDX Hawaii PPO	$0.33
Rate for Payer: Ohana Health Plan Medicaid	$0.14
Rate for Payer: Ohana Health Plan Medicare	$0.14
Rate for Payer: UnitedHealthcare Medicaid	$0.20
Rate for Payer: UnitedHealthcare Medicare	$0.14
Rate for Payer: University Health Alliance Commercial	$0.25

fluconazole 50 mg Tab [KMC]

Facility

$22.28

Service Code	NDC 70710113703
Hospital Revenue Code	250
Min. Negotiated Rate	$18.94
Max. Negotiated Rate	$21.61
Rate for Payer: Cash Price	$14.48
Rate for Payer: Health Management Network Commercial	$18.94
Rate for Payer: Kaiser Permanente Commercial	$20.05
Rate for Payer: MDX Hawaii PPO	$21.61

fluconazole 50 mg Tab [KMC]

Facility

$22.28

Service Code	NDC 70710113703
Hospital Revenue Code	250
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$21.61
Rate for Payer: AlohaCare Medicaid	$11.14
Rate for Payer: AlohaCare Medicare	$9.36
Rate for Payer: Cash Price	$14.48
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$20.50
Rate for Payer: Devoted Health Medicare	$9.36
Rate for Payer: Hawaii Medical Service Association Medicare	$9.36
Rate for Payer: Hawaii Western Management Group Commercial	$21.17
Rate for Payer: Health Management Network Commercial	$18.94
Rate for Payer: Humana Medicare	$9.36
Rate for Payer: Kaiser Permanente Commercial	$20.05
Rate for Payer: Kaiser Permanente Medicaid	$11.36
Rate for Payer: Kaiser Permanente Medicare	$9.36
Rate for Payer: MDX Hawaii PPO	$21.61
Rate for Payer: Ohana Health Plan Medicaid	$9.36
Rate for Payer: Ohana Health Plan Medicare	$9.36
Rate for Payer: UnitedHealthcare Medicaid	$13.37
Rate for Payer: UnitedHealthcare Medicare	$9.36
Rate for Payer: University Health Alliance Commercial	$16.24

fludocortisone 0.1 mg tab [KMC]

Facility

$3.00

Service Code	NDC 42291076401
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

fludocortisone 0.1 mg tab [KMC]

Facility

$3.00

Service Code	NDC 42291076401
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

FLU IMMUNO ADMIND/PREVIOUSLY RCVD

Professional

Both

$0.01

Service Code	HCPCS 4274F
Hospital Revenue Code	521
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$290.48
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

flumazenil 0.1 mg/mL IV Sol [KMC]

Facility

$6.24

Service Code	NDC 00143968410
Hospital Revenue Code	250
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$6.05
Rate for Payer: Cash Price	$4.06
Rate for Payer: Health Management Network Commercial	$5.30
Rate for Payer: Kaiser Permanente Commercial	$5.62
Rate for Payer: MDX Hawaii PPO	$6.05

flumazenil 0.1 mg/mL IV Sol [KMC]

Facility

$6.24

Service Code	NDC 00143968410
Hospital Revenue Code	250
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$6.05
Rate for Payer: AlohaCare Medicaid	$3.12
Rate for Payer: AlohaCare Medicare	$2.62
Rate for Payer: Cash Price	$4.06
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.74
Rate for Payer: Devoted Health Medicare	$2.62
Rate for Payer: Hawaii Medical Service Association Medicare	$2.62
Rate for Payer: Hawaii Western Management Group Commercial	$5.93
Rate for Payer: Health Management Network Commercial	$5.30
Rate for Payer: Humana Medicare	$2.62
Rate for Payer: Kaiser Permanente Commercial	$5.62
Rate for Payer: Kaiser Permanente Medicaid	$3.18
Rate for Payer: Kaiser Permanente Medicare	$2.62
Rate for Payer: MDX Hawaii PPO	$6.05
Rate for Payer: Ohana Health Plan Medicaid	$2.62
Rate for Payer: Ohana Health Plan Medicare	$2.62
Rate for Payer: UnitedHealthcare Medicaid	$3.74
Rate for Payer: UnitedHealthcare Medicare	$2.62
Rate for Payer: University Health Alliance Commercial	$4.55

flunisolide 80 mcg inhaler [KMC]

Facility

$628.08

Service Code	NDC 75989055012
Hospital Revenue Code	250
Min. Negotiated Rate	$263.79
Max. Negotiated Rate	$609.24
Rate for Payer: AlohaCare Medicaid	$314.04
Rate for Payer: AlohaCare Medicare	$263.79
Rate for Payer: Cash Price	$408.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$577.83
Rate for Payer: Devoted Health Medicare	$263.79
Rate for Payer: Hawaii Medical Service Association Medicare	$263.79
Rate for Payer: Hawaii Western Management Group Commercial	$596.68
Rate for Payer: Health Management Network Commercial	$533.87
Rate for Payer: Humana Medicare	$263.79
Rate for Payer: Kaiser Permanente Commercial	$565.27
Rate for Payer: Kaiser Permanente Medicaid	$320.32
Rate for Payer: Kaiser Permanente Medicare	$263.79
Rate for Payer: MDX Hawaii PPO	$609.24
Rate for Payer: Ohana Health Plan Medicaid	$263.79
Rate for Payer: Ohana Health Plan Medicare	$263.79
Rate for Payer: UnitedHealthcare Medicaid	$376.85
Rate for Payer: UnitedHealthcare Medicare	$263.79
Rate for Payer: University Health Alliance Commercial	$457.81

flunisolide 80 mcg inhaler [KMC]

Facility

$628.08

Service Code	NDC 75989055012
Hospital Revenue Code	250
Min. Negotiated Rate	$533.87
Max. Negotiated Rate	$609.24
Rate for Payer: Cash Price	$408.25
Rate for Payer: Health Management Network Commercial	$533.87
Rate for Payer: Kaiser Permanente Commercial	$565.27
Rate for Payer: MDX Hawaii PPO	$609.24

fluocinonide 0.1% cream [KMC]

Facility

$2.65

Service Code	NDC 45802015194
Hospital Revenue Code	250
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$2.57
Rate for Payer: AlohaCare Medicaid	$1.32
Rate for Payer: AlohaCare Medicare	$1.11
Rate for Payer: Cash Price	$1.72
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.44
Rate for Payer: Devoted Health Medicare	$1.11
Rate for Payer: Hawaii Medical Service Association Medicare	$1.11
Rate for Payer: Hawaii Western Management Group Commercial	$2.52
Rate for Payer: Health Management Network Commercial	$2.25
Rate for Payer: Humana Medicare	$1.11
Rate for Payer: Kaiser Permanente Commercial	$2.38
Rate for Payer: Kaiser Permanente Medicaid	$1.35
Rate for Payer: Kaiser Permanente Medicare	$1.11
Rate for Payer: MDX Hawaii PPO	$2.57
Rate for Payer: Ohana Health Plan Medicaid	$1.11
Rate for Payer: Ohana Health Plan Medicare	$1.11
Rate for Payer: UnitedHealthcare Medicaid	$1.59
Rate for Payer: UnitedHealthcare Medicare	$1.11
Rate for Payer: University Health Alliance Commercial	$1.93

fluocinonide 0.1% cream [KMC]

Facility

$2.65

Service Code	NDC 45802015194
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.57
Rate for Payer: Cash Price	$1.72
Rate for Payer: Health Management Network Commercial	$2.25
Rate for Payer: Kaiser Permanente Commercial	$2.38
Rate for Payer: MDX Hawaii PPO	$2.57

fluorescein ophthalmic 1 mg Test [KMC]

Facility

$3.00

Service Code	NDC 17478040401
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

fluorescein ophthalmic 1 mg Test [KMC]

Facility

$3.00

Service Code	NDC 17478040401
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

fluoride 1.1% topical Cream [KMC]

Facility

$0.63

Service Code	NDC 64980030550
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.61
Rate for Payer: AlohaCare Medicaid	$0.32
Rate for Payer: AlohaCare Medicare	$0.26
Rate for Payer: Cash Price	$0.41
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.58
Rate for Payer: Devoted Health Medicare	$0.26
Rate for Payer: Hawaii Medical Service Association Medicare	$0.26
Rate for Payer: Hawaii Western Management Group Commercial	$0.60
Rate for Payer: Health Management Network Commercial	$0.54
Rate for Payer: Humana Medicare	$0.26
Rate for Payer: Kaiser Permanente Commercial	$0.57
Rate for Payer: Kaiser Permanente Medicaid	$0.32
Rate for Payer: Kaiser Permanente Medicare	$0.26
Rate for Payer: MDX Hawaii PPO	$0.61
Rate for Payer: Ohana Health Plan Medicaid	$0.26
Rate for Payer: Ohana Health Plan Medicare	$0.26
Rate for Payer: UnitedHealthcare Medicaid	$0.38
Rate for Payer: UnitedHealthcare Medicare	$0.26
Rate for Payer: University Health Alliance Commercial	$0.46

Know your out-of-pocket cost for care.

All Charges