Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

fluoride 1.1% topical Cream [KMC]

Facility

$0.63

Service Code	NDC 64980030550
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.61
Rate for Payer: Cash Price	$0.41
Rate for Payer: Health Management Network Commercial	$0.54
Rate for Payer: Kaiser Permanente Commercial	$0.57
Rate for Payer: MDX Hawaii PPO	$0.61

fluorouracil 5% topical Cream [KMC]

Facility

$38.49

Service Code	NDC 51672411806
Hospital Revenue Code	250
Min. Negotiated Rate	$32.72
Max. Negotiated Rate	$37.34
Rate for Payer: Cash Price	$25.02
Rate for Payer: Health Management Network Commercial	$32.72
Rate for Payer: Kaiser Permanente Commercial	$34.64
Rate for Payer: MDX Hawaii PPO	$37.34

fluorouracil 5% topical Cream [KMC]

Facility

$38.49

Service Code	NDC 51672411806
Hospital Revenue Code	250
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$37.34
Rate for Payer: AlohaCare Medicaid	$19.25
Rate for Payer: AlohaCare Medicare	$16.17
Rate for Payer: Cash Price	$25.02
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$35.41
Rate for Payer: Devoted Health Medicare	$16.17
Rate for Payer: Hawaii Medical Service Association Medicare	$16.17
Rate for Payer: Hawaii Western Management Group Commercial	$36.57
Rate for Payer: Health Management Network Commercial	$32.72
Rate for Payer: Humana Medicare	$16.17
Rate for Payer: Kaiser Permanente Commercial	$34.64
Rate for Payer: Kaiser Permanente Medicaid	$19.63
Rate for Payer: Kaiser Permanente Medicare	$16.17
Rate for Payer: MDX Hawaii PPO	$37.34
Rate for Payer: Ohana Health Plan Medicaid	$16.17
Rate for Payer: Ohana Health Plan Medicare	$16.17
Rate for Payer: UnitedHealthcare Medicaid	$23.09
Rate for Payer: UnitedHealthcare Medicare	$16.17
Rate for Payer: University Health Alliance Commercial	$28.06

FLUoxetine 10 mg Cap [KMC]

Facility

$10.39

Service Code	NDC 16714072002
Hospital Revenue Code	250
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$10.08
Rate for Payer: AlohaCare Medicaid	$5.20
Rate for Payer: AlohaCare Medicare	$4.36
Rate for Payer: Cash Price	$6.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$9.56
Rate for Payer: Devoted Health Medicare	$4.36
Rate for Payer: Hawaii Medical Service Association Medicare	$4.36
Rate for Payer: Hawaii Western Management Group Commercial	$9.87
Rate for Payer: Health Management Network Commercial	$8.83
Rate for Payer: Humana Medicare	$4.36
Rate for Payer: Kaiser Permanente Commercial	$9.35
Rate for Payer: Kaiser Permanente Medicaid	$5.30
Rate for Payer: Kaiser Permanente Medicare	$4.36
Rate for Payer: MDX Hawaii PPO	$10.08
Rate for Payer: Ohana Health Plan Medicaid	$4.36
Rate for Payer: Ohana Health Plan Medicare	$4.36
Rate for Payer: UnitedHealthcare Medicaid	$6.23
Rate for Payer: UnitedHealthcare Medicare	$4.36
Rate for Payer: University Health Alliance Commercial	$7.57

FLUoxetine 10 mg Cap [KMC]

Facility

$10.39

Service Code	NDC 16714072002
Hospital Revenue Code	250
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$10.08
Rate for Payer: Cash Price	$6.75
Rate for Payer: Health Management Network Commercial	$8.83
Rate for Payer: Kaiser Permanente Commercial	$9.35
Rate for Payer: MDX Hawaii PPO	$10.08

FLUoxetine 20 mg Cap [KMC]

Facility

$10.67

Service Code	NDC 16714072102
Hospital Revenue Code	250
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$10.35
Rate for Payer: Cash Price	$6.94
Rate for Payer: Health Management Network Commercial	$9.07
Rate for Payer: Kaiser Permanente Commercial	$9.60
Rate for Payer: MDX Hawaii PPO	$10.35

FLUoxetine 20 mg Cap [KMC]

Facility

$10.67

Service Code	NDC 16714072102
Hospital Revenue Code	250
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$10.35
Rate for Payer: AlohaCare Medicaid	$5.33
Rate for Payer: AlohaCare Medicare	$4.48
Rate for Payer: Cash Price	$6.94
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$9.82
Rate for Payer: Devoted Health Medicare	$4.48
Rate for Payer: Hawaii Medical Service Association Medicare	$4.48
Rate for Payer: Hawaii Western Management Group Commercial	$10.14
Rate for Payer: Health Management Network Commercial	$9.07
Rate for Payer: Humana Medicare	$4.48
Rate for Payer: Kaiser Permanente Commercial	$9.60
Rate for Payer: Kaiser Permanente Medicaid	$5.44
Rate for Payer: Kaiser Permanente Medicare	$4.48
Rate for Payer: MDX Hawaii PPO	$10.35
Rate for Payer: Ohana Health Plan Medicaid	$4.48
Rate for Payer: Ohana Health Plan Medicare	$4.48
Rate for Payer: UnitedHealthcare Medicaid	$6.40
Rate for Payer: UnitedHealthcare Medicare	$4.48
Rate for Payer: University Health Alliance Commercial	$7.78

fluticasone 220 mcg inhaler [KMC]

Facility

$160.36

Service Code	NDC 00173072020
Hospital Revenue Code	250
Min. Negotiated Rate	$136.31
Max. Negotiated Rate	$155.55
Rate for Payer: Cash Price	$104.23
Rate for Payer: Health Management Network Commercial	$136.31
Rate for Payer: Kaiser Permanente Commercial	$144.32
Rate for Payer: MDX Hawaii PPO	$155.55

fluticasone 220 mcg inhaler [KMC]

Facility

$160.36

Service Code	NDC 00173072020
Hospital Revenue Code	250
Min. Negotiated Rate	$67.35
Max. Negotiated Rate	$155.55
Rate for Payer: AlohaCare Medicaid	$80.18
Rate for Payer: AlohaCare Medicare	$67.35
Rate for Payer: Cash Price	$104.23
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$147.53
Rate for Payer: Devoted Health Medicare	$67.35
Rate for Payer: Hawaii Medical Service Association Medicare	$67.35
Rate for Payer: Hawaii Western Management Group Commercial	$152.34
Rate for Payer: Health Management Network Commercial	$136.31
Rate for Payer: Humana Medicare	$67.35
Rate for Payer: Kaiser Permanente Commercial	$144.32
Rate for Payer: Kaiser Permanente Medicaid	$81.78
Rate for Payer: Kaiser Permanente Medicare	$67.35
Rate for Payer: MDX Hawaii PPO	$155.55
Rate for Payer: Ohana Health Plan Medicaid	$67.35
Rate for Payer: Ohana Health Plan Medicare	$67.35
Rate for Payer: UnitedHealthcare Medicaid	$96.22
Rate for Payer: UnitedHealthcare Medicare	$67.35
Rate for Payer: University Health Alliance Commercial	$116.89

fluticasone 44 mcg inhaler [KMC]

Facility

$92.62

Service Code	NDC 00173071820
Hospital Revenue Code	250
Min. Negotiated Rate	$38.90
Max. Negotiated Rate	$89.84
Rate for Payer: AlohaCare Medicaid	$46.31
Rate for Payer: AlohaCare Medicare	$38.90
Rate for Payer: Cash Price	$60.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$85.21
Rate for Payer: Devoted Health Medicare	$38.90
Rate for Payer: Hawaii Medical Service Association Medicare	$38.90
Rate for Payer: Hawaii Western Management Group Commercial	$87.99
Rate for Payer: Health Management Network Commercial	$78.73
Rate for Payer: Humana Medicare	$38.90
Rate for Payer: Kaiser Permanente Commercial	$83.36
Rate for Payer: Kaiser Permanente Medicaid	$47.24
Rate for Payer: Kaiser Permanente Medicare	$38.90
Rate for Payer: MDX Hawaii PPO	$89.84
Rate for Payer: Ohana Health Plan Medicaid	$38.90
Rate for Payer: Ohana Health Plan Medicare	$38.90
Rate for Payer: UnitedHealthcare Medicaid	$55.57
Rate for Payer: UnitedHealthcare Medicare	$38.90
Rate for Payer: University Health Alliance Commercial	$67.51

fluticasone 44 mcg inhaler [KMC]

Facility

$92.62

Service Code	NDC 00173071820
Hospital Revenue Code	250
Min. Negotiated Rate	$78.73
Max. Negotiated Rate	$89.84
Rate for Payer: Cash Price	$60.20
Rate for Payer: Health Management Network Commercial	$78.73
Rate for Payer: Kaiser Permanente Commercial	$83.36
Rate for Payer: MDX Hawaii PPO	$89.84

fluticasone 50 mcg nasal spray [KMC]

Facility

$18.82

Service Code	NDC 00054327099
Hospital Revenue Code	250
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$18.26
Rate for Payer: Cash Price	$12.23
Rate for Payer: Health Management Network Commercial	$16.00
Rate for Payer: Kaiser Permanente Commercial	$16.94
Rate for Payer: MDX Hawaii PPO	$18.26

fluticasone 50 mcg nasal spray [KMC]

Facility

$18.82

Service Code	NDC 00054327099
Hospital Revenue Code	250
Min. Negotiated Rate	$7.90
Max. Negotiated Rate	$18.26
Rate for Payer: AlohaCare Medicaid	$9.41
Rate for Payer: AlohaCare Medicare	$7.90
Rate for Payer: Cash Price	$12.23
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$17.31
Rate for Payer: Devoted Health Medicare	$7.90
Rate for Payer: Hawaii Medical Service Association Medicare	$7.90
Rate for Payer: Hawaii Western Management Group Commercial	$17.88
Rate for Payer: Health Management Network Commercial	$16.00
Rate for Payer: Humana Medicare	$7.90
Rate for Payer: Kaiser Permanente Commercial	$16.94
Rate for Payer: Kaiser Permanente Medicaid	$9.60
Rate for Payer: Kaiser Permanente Medicare	$7.90
Rate for Payer: MDX Hawaii PPO	$18.26
Rate for Payer: Ohana Health Plan Medicaid	$7.90
Rate for Payer: Ohana Health Plan Medicare	$7.90
Rate for Payer: UnitedHealthcare Medicaid	$11.29
Rate for Payer: UnitedHealthcare Medicare	$7.90
Rate for Payer: University Health Alliance Commercial	$13.72

fluticasone furoate 100 mcg inhaler [KMC]

Facility

$30.34

Service Code	NDC 00173087410
Hospital Revenue Code	250
Min. Negotiated Rate	$25.79
Max. Negotiated Rate	$29.43
Rate for Payer: Cash Price	$19.72
Rate for Payer: Health Management Network Commercial	$25.79
Rate for Payer: Kaiser Permanente Commercial	$27.31
Rate for Payer: MDX Hawaii PPO	$29.43

fluticasone furoate 100 mcg inhaler [KMC]

Facility

$30.34

Service Code	NDC 00173087410
Hospital Revenue Code	250
Min. Negotiated Rate	$12.74
Max. Negotiated Rate	$29.43
Rate for Payer: AlohaCare Medicaid	$15.17
Rate for Payer: AlohaCare Medicare	$12.74
Rate for Payer: Cash Price	$19.72
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$27.91
Rate for Payer: Devoted Health Medicare	$12.74
Rate for Payer: Hawaii Medical Service Association Medicare	$12.74
Rate for Payer: Hawaii Western Management Group Commercial	$28.82
Rate for Payer: Health Management Network Commercial	$25.79
Rate for Payer: Humana Medicare	$12.74
Rate for Payer: Kaiser Permanente Commercial	$27.31
Rate for Payer: Kaiser Permanente Medicaid	$15.47
Rate for Payer: Kaiser Permanente Medicare	$12.74
Rate for Payer: MDX Hawaii PPO	$29.43
Rate for Payer: Ohana Health Plan Medicaid	$12.74
Rate for Payer: Ohana Health Plan Medicare	$12.74
Rate for Payer: UnitedHealthcare Medicaid	$18.20
Rate for Payer: UnitedHealthcare Medicare	$12.74
Rate for Payer: University Health Alliance Commercial	$22.11

fluticasone-salmeterol 100-50 mcg inhaler [KMC]

Facility

$24.10

Service Code	NDC 00054032656
Hospital Revenue Code	250
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$23.38
Rate for Payer: AlohaCare Medicaid	$12.05
Rate for Payer: AlohaCare Medicare	$10.12
Rate for Payer: Cash Price	$15.66
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$22.17
Rate for Payer: Devoted Health Medicare	$10.12
Rate for Payer: Hawaii Medical Service Association Medicare	$10.12
Rate for Payer: Hawaii Western Management Group Commercial	$22.89
Rate for Payer: Health Management Network Commercial	$20.48
Rate for Payer: Humana Medicare	$10.12
Rate for Payer: Kaiser Permanente Commercial	$21.69
Rate for Payer: Kaiser Permanente Medicaid	$12.29
Rate for Payer: Kaiser Permanente Medicare	$10.12
Rate for Payer: MDX Hawaii PPO	$23.38
Rate for Payer: Ohana Health Plan Medicaid	$10.12
Rate for Payer: Ohana Health Plan Medicare	$10.12
Rate for Payer: UnitedHealthcare Medicaid	$14.46
Rate for Payer: UnitedHealthcare Medicare	$10.12
Rate for Payer: University Health Alliance Commercial	$17.57

fluticasone-salmeterol 100-50 mcg inhaler [KMC]

Facility

$24.10

Service Code	NDC 00054032656
Hospital Revenue Code	250
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$23.38
Rate for Payer: Cash Price	$15.66
Rate for Payer: Health Management Network Commercial	$20.48
Rate for Payer: Kaiser Permanente Commercial	$21.69
Rate for Payer: MDX Hawaii PPO	$23.38

fluticasone-salmeterol 250-50 mcg inhaler [KMC]

Facility

$29.62

Service Code	NDC 66993058597
Hospital Revenue Code	250
Min. Negotiated Rate	$25.18
Max. Negotiated Rate	$28.73
Rate for Payer: Cash Price	$19.25
Rate for Payer: Health Management Network Commercial	$25.18
Rate for Payer: Kaiser Permanente Commercial	$26.66
Rate for Payer: MDX Hawaii PPO	$28.73

fluticasone-salmeterol 250-50 mcg inhaler [KMC]

Facility

$29.62

Service Code	NDC 66993058597
Hospital Revenue Code	250
Min. Negotiated Rate	$12.44
Max. Negotiated Rate	$28.73
Rate for Payer: AlohaCare Medicaid	$14.81
Rate for Payer: AlohaCare Medicare	$12.44
Rate for Payer: Cash Price	$19.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$27.25
Rate for Payer: Devoted Health Medicare	$12.44
Rate for Payer: Hawaii Medical Service Association Medicare	$12.44
Rate for Payer: Hawaii Western Management Group Commercial	$28.14
Rate for Payer: Health Management Network Commercial	$25.18
Rate for Payer: Humana Medicare	$12.44
Rate for Payer: Kaiser Permanente Commercial	$26.66
Rate for Payer: Kaiser Permanente Medicaid	$15.11
Rate for Payer: Kaiser Permanente Medicare	$12.44
Rate for Payer: MDX Hawaii PPO	$28.73
Rate for Payer: Ohana Health Plan Medicaid	$12.44
Rate for Payer: Ohana Health Plan Medicare	$12.44
Rate for Payer: UnitedHealthcare Medicaid	$17.77
Rate for Payer: UnitedHealthcare Medicare	$12.44
Rate for Payer: University Health Alliance Commercial	$21.59

fluticasone-salmeterol 500-50 mcg inhaler [KMC]

Facility

$39.38

Service Code	NDC 00093751631
Hospital Revenue Code	250
Min. Negotiated Rate	$33.47
Max. Negotiated Rate	$38.20
Rate for Payer: Cash Price	$25.60
Rate for Payer: Health Management Network Commercial	$33.47
Rate for Payer: Kaiser Permanente Commercial	$35.44
Rate for Payer: MDX Hawaii PPO	$38.20

fluticasone-salmeterol 500-50 mcg inhaler [KMC]

Facility

$39.38

Service Code	NDC 00093751631
Hospital Revenue Code	250
Min. Negotiated Rate	$16.54
Max. Negotiated Rate	$38.20
Rate for Payer: AlohaCare Medicaid	$19.69
Rate for Payer: AlohaCare Medicare	$16.54
Rate for Payer: Cash Price	$25.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$36.23
Rate for Payer: Devoted Health Medicare	$16.54
Rate for Payer: Hawaii Medical Service Association Medicare	$16.54
Rate for Payer: Hawaii Western Management Group Commercial	$37.41
Rate for Payer: Health Management Network Commercial	$33.47
Rate for Payer: Humana Medicare	$16.54
Rate for Payer: Kaiser Permanente Commercial	$35.44
Rate for Payer: Kaiser Permanente Medicaid	$20.08
Rate for Payer: Kaiser Permanente Medicare	$16.54
Rate for Payer: MDX Hawaii PPO	$38.20
Rate for Payer: Ohana Health Plan Medicaid	$16.54
Rate for Payer: Ohana Health Plan Medicare	$16.54
Rate for Payer: UnitedHealthcare Medicaid	$23.63
Rate for Payer: UnitedHealthcare Medicare	$16.54
Rate for Payer: University Health Alliance Commercial	$28.70

fluticasone-umeclidinium-vilanterol 100-62.5-25 mcg inhaler

Facility

$45.79

Service Code	NDC 00173088714
Hospital Revenue Code	250
Min. Negotiated Rate	$19.23
Max. Negotiated Rate	$44.42
Rate for Payer: AlohaCare Medicaid	$22.89
Rate for Payer: AlohaCare Medicare	$19.23
Rate for Payer: Cash Price	$29.76
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$42.13
Rate for Payer: Devoted Health Medicare	$19.23
Rate for Payer: Hawaii Medical Service Association Medicare	$19.23
Rate for Payer: Hawaii Western Management Group Commercial	$43.50
Rate for Payer: Health Management Network Commercial	$38.92
Rate for Payer: Humana Medicare	$19.23
Rate for Payer: Kaiser Permanente Commercial	$41.21
Rate for Payer: Kaiser Permanente Medicaid	$23.35
Rate for Payer: Kaiser Permanente Medicare	$19.23
Rate for Payer: MDX Hawaii PPO	$44.42
Rate for Payer: Ohana Health Plan Medicaid	$19.23
Rate for Payer: Ohana Health Plan Medicare	$19.23
Rate for Payer: UnitedHealthcare Medicaid	$27.47
Rate for Payer: UnitedHealthcare Medicare	$19.23
Rate for Payer: University Health Alliance Commercial	$33.38

fluticasone-umeclidinium-vilanterol 100-62.5-25 mcg inhaler

Facility

$45.79

Service Code	NDC 00173088714
Hospital Revenue Code	250
Min. Negotiated Rate	$38.92
Max. Negotiated Rate	$44.42
Rate for Payer: Cash Price	$29.76
Rate for Payer: Health Management Network Commercial	$38.92
Rate for Payer: Kaiser Permanente Commercial	$41.21
Rate for Payer: MDX Hawaii PPO	$44.42

fluticasone-umeclidinium-vilanterol 200-62.5-25 mcg inhaler

Facility

$51.08

Service Code	NDC 00173089310
Hospital Revenue Code	250
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$49.55
Rate for Payer: AlohaCare Medicaid	$25.54
Rate for Payer: AlohaCare Medicare	$21.45
Rate for Payer: Cash Price	$33.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$46.99
Rate for Payer: Devoted Health Medicare	$21.45
Rate for Payer: Hawaii Medical Service Association Medicare	$21.45
Rate for Payer: Hawaii Western Management Group Commercial	$48.53
Rate for Payer: Health Management Network Commercial	$43.42
Rate for Payer: Humana Medicare	$21.45
Rate for Payer: Kaiser Permanente Commercial	$45.97
Rate for Payer: Kaiser Permanente Medicaid	$26.05
Rate for Payer: Kaiser Permanente Medicare	$21.45
Rate for Payer: MDX Hawaii PPO	$49.55
Rate for Payer: Ohana Health Plan Medicaid	$21.45
Rate for Payer: Ohana Health Plan Medicare	$21.45
Rate for Payer: UnitedHealthcare Medicaid	$30.65
Rate for Payer: UnitedHealthcare Medicare	$21.45
Rate for Payer: University Health Alliance Commercial	$37.23

fluticasone-umeclidinium-vilanterol 200-62.5-25 mcg inhaler

Facility

$51.08

Service Code	NDC 00173089310
Hospital Revenue Code	250
Min. Negotiated Rate	$43.42
Max. Negotiated Rate	$49.55
Rate for Payer: Cash Price	$33.20
Rate for Payer: Health Management Network Commercial	$43.42
Rate for Payer: Kaiser Permanente Commercial	$45.97
Rate for Payer: MDX Hawaii PPO	$49.55

Know your out-of-pocket cost for care.

All Charges