Kau Hospital

All Charges

Charge

Type

Setting

Price

FLOSEAL HEMOSTATC 10ML 1505291

Facility

$1,356.00

Hospital Revenue Code	250
Min. Negotiated Rate	$1,152.60
Max. Negotiated Rate	$1,315.32
Rate for Payer: Cash Price	$813.60
Rate for Payer: Health Management Network Commercial	$1,152.60
Rate for Payer: Kaiser Permanente Commercial	$1,220.40
Rate for Payer: MDX Hawaii PPO	$1,315.32

FLOSEAL HEMOSTATC 10ML 1505291

Facility

$1,356.00

Hospital Revenue Code	250
Min. Negotiated Rate	$420.36
Max. Negotiated Rate	$1,315.32
Rate for Payer: AlohaCare Medicaid	$678.00
Rate for Payer: AlohaCare Medicare	$420.36
Rate for Payer: Cash Price	$813.60
Rate for Payer: Devoted Health Medicare	$461.04
Rate for Payer: Hawaii Medical Service Association Medicare	$420.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,288.20
Rate for Payer: Health Management Network Commercial	$1,152.60
Rate for Payer: Humana Medicare	$420.36
Rate for Payer: Kaiser Permanente Commercial	$1,220.40
Rate for Payer: Kaiser Permanente Medicaid	$691.56
Rate for Payer: Kaiser Permanente Medicare	$420.36
Rate for Payer: MDX Hawaii PPO	$1,315.32
Rate for Payer: Ohana Health Plan Medicaid	$420.36
Rate for Payer: Ohana Health Plan Medicare	$420.36
Rate for Payer: UnitedHealthcare Medicaid	$813.60
Rate for Payer: UnitedHealthcare Medicare	$420.36
Rate for Payer: University Health Alliance Commercial	$988.39

FLOSEAL HEMOSTATIC ADS202105

Facility

$911.00

Hospital Revenue Code	250
Min. Negotiated Rate	$774.35
Max. Negotiated Rate	$883.67
Rate for Payer: Cash Price	$546.60
Rate for Payer: Health Management Network Commercial	$774.35
Rate for Payer: Kaiser Permanente Commercial	$819.90
Rate for Payer: MDX Hawaii PPO	$883.67

FLOSEAL HEMOSTATIC ADS202105

Facility

$911.00

Hospital Revenue Code	250
Min. Negotiated Rate	$282.41
Max. Negotiated Rate	$883.67
Rate for Payer: AlohaCare Medicaid	$455.50
Rate for Payer: AlohaCare Medicare	$282.41
Rate for Payer: Cash Price	$546.60
Rate for Payer: Devoted Health Medicare	$309.74
Rate for Payer: Hawaii Medical Service Association Medicare	$282.41
Rate for Payer: Hawaii Western Management Group Commercial	$865.45
Rate for Payer: Health Management Network Commercial	$774.35
Rate for Payer: Humana Medicare	$282.41
Rate for Payer: Kaiser Permanente Commercial	$819.90
Rate for Payer: Kaiser Permanente Medicaid	$464.61
Rate for Payer: Kaiser Permanente Medicare	$282.41
Rate for Payer: MDX Hawaii PPO	$883.67
Rate for Payer: Ohana Health Plan Medicaid	$282.41
Rate for Payer: Ohana Health Plan Medicare	$282.41
Rate for Payer: UnitedHealthcare Medicaid	$546.60
Rate for Payer: UnitedHealthcare Medicare	$282.41
Rate for Payer: University Health Alliance Commercial	$664.03

FLT3 GENE ANLYS TYROSINE KINASE DOMAIN VARIANTS

Facility

$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: Kaiser Permanente Commercial	$626.40
Rate for Payer: MDX Hawaii PPO	$675.12

FLT3 GENE ANLYS TYROSINE KINASE DOMAIN VARIANTS

Facility

$696.00

Service Code	HCPCS 81246
Hospital Charge Code	3108124601
Hospital Revenue Code	310
Min. Negotiated Rate	$62.25
Max. Negotiated Rate	$675.12
Rate for Payer: AlohaCare Medicaid	$348.00
Rate for Payer: AlohaCare Medicare	$215.76
Rate for Payer: Cash Price	$417.60
Rate for Payer: Cash Price	$417.60
Rate for Payer: Devoted Health Medicare	$236.64
Rate for Payer: Hawaii Medical Service Association ABD	$83.04
Rate for Payer: Hawaii Medical Service Association Commercial	$103.75
Rate for Payer: Hawaii Medical Service Association Medicare	$215.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$83.04
Rate for Payer: Hawaii Western Management Group Commercial	$83.00
Rate for Payer: Health Management Network Commercial	$591.60
Rate for Payer: Humana Medicare	$215.76
Rate for Payer: Kaiser Permanente Commercial	$626.40
Rate for Payer: Kaiser Permanente Medicaid	$354.96
Rate for Payer: Kaiser Permanente Medicare	$215.76
Rate for Payer: MDX Hawaii PPO	$675.12
Rate for Payer: Ohana Health Plan Medicaid	$215.76
Rate for Payer: Ohana Health Plan Medicare	$215.76
Rate for Payer: UnitedHealthcare Medicaid	$62.25
Rate for Payer: UnitedHealthcare Medicare	$215.76
Rate for Payer: University Health Alliance Commercial	$507.31

FLUCONAZOLE 100 MG TABLET [10044]

Facility

$29.00

Service Code	NDC 50268033711
Hospital Revenue Code	637
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$28.13
Rate for Payer: AlohaCare Medicaid	$14.50
Rate for Payer: AlohaCare Medicare	$8.99
Rate for Payer: Cash Price	$17.40
Rate for Payer: Devoted Health Medicare	$9.86
Rate for Payer: Hawaii Medical Service Association Medicare	$8.99
Rate for Payer: Hawaii Western Management Group Commercial	$27.55
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Humana Medicare	$8.99
Rate for Payer: Kaiser Permanente Commercial	$26.10
Rate for Payer: Kaiser Permanente Medicaid	$14.79
Rate for Payer: Kaiser Permanente Medicare	$8.99
Rate for Payer: MDX Hawaii PPO	$28.13
Rate for Payer: Ohana Health Plan Medicaid	$8.99
Rate for Payer: Ohana Health Plan Medicare	$8.99
Rate for Payer: UnitedHealthcare Medicare	$8.99
Rate for Payer: University Health Alliance Commercial	$21.14

FLUCONAZOLE 100 MG TABLET [10044]

Facility

$27.00

Service Code	NDC 57237000430
Hospital Revenue Code	637
Min. Negotiated Rate	$8.37
Max. Negotiated Rate	$26.19
Rate for Payer: AlohaCare Medicaid	$13.50
Rate for Payer: AlohaCare Medicare	$8.37
Rate for Payer: Cash Price	$16.20
Rate for Payer: Devoted Health Medicare	$9.18
Rate for Payer: Hawaii Medical Service Association Medicare	$8.37
Rate for Payer: Hawaii Western Management Group Commercial	$25.65
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Humana Medicare	$8.37
Rate for Payer: Kaiser Permanente Commercial	$24.30
Rate for Payer: Kaiser Permanente Medicaid	$13.77
Rate for Payer: Kaiser Permanente Medicare	$8.37
Rate for Payer: MDX Hawaii PPO	$26.19
Rate for Payer: Ohana Health Plan Medicaid	$8.37
Rate for Payer: Ohana Health Plan Medicare	$8.37
Rate for Payer: UnitedHealthcare Medicare	$8.37
Rate for Payer: University Health Alliance Commercial	$19.68

FLUCONAZOLE 100 MG TABLET [10044]

Facility

$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: Kaiser Permanente Commercial	$24.30
Rate for Payer: MDX Hawaii PPO	$26.19

FLUCONAZOLE 100 MG TABLET [10044]

Facility

$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: Kaiser Permanente Commercial	$26.10
Rate for Payer: MDX Hawaii PPO	$28.13

FLUCONAZOLE 100 MG TABLET [10044]

Facility

$29.00

Service Code	NDC 50268033715
Hospital Revenue Code	637
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$28.13
Rate for Payer: AlohaCare Medicaid	$14.50
Rate for Payer: AlohaCare Medicare	$8.99
Rate for Payer: Cash Price	$17.40
Rate for Payer: Devoted Health Medicare	$9.86
Rate for Payer: Hawaii Medical Service Association Medicare	$8.99
Rate for Payer: Hawaii Western Management Group Commercial	$27.55
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Humana Medicare	$8.99
Rate for Payer: Kaiser Permanente Commercial	$26.10
Rate for Payer: Kaiser Permanente Medicaid	$14.79
Rate for Payer: Kaiser Permanente Medicare	$8.99
Rate for Payer: MDX Hawaii PPO	$28.13
Rate for Payer: Ohana Health Plan Medicaid	$8.99
Rate for Payer: Ohana Health Plan Medicare	$8.99
Rate for Payer: UnitedHealthcare Medicare	$8.99
Rate for Payer: University Health Alliance Commercial	$21.14

FLUCONAZOLE 100 MG TABLET [10044]

Facility

$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: Kaiser Permanente Commercial	$26.10
Rate for Payer: MDX Hawaii PPO	$28.13

FLUCONAZOLE 100 MG TABLET [10044]

Facility

$30.00

Service Code	NDC 00904650061
Hospital Revenue Code	637
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$29.10
Rate for Payer: AlohaCare Medicaid	$15.00
Rate for Payer: AlohaCare Medicare	$9.30
Rate for Payer: Cash Price	$18.00
Rate for Payer: Devoted Health Medicare	$10.20
Rate for Payer: Hawaii Medical Service Association Medicare	$9.30
Rate for Payer: Hawaii Western Management Group Commercial	$28.50
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Humana Medicare	$9.30
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: Kaiser Permanente Medicaid	$15.30
Rate for Payer: Kaiser Permanente Medicare	$9.30
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: Ohana Health Plan Medicaid	$9.30
Rate for Payer: Ohana Health Plan Medicare	$9.30
Rate for Payer: UnitedHealthcare Medicare	$9.30
Rate for Payer: University Health Alliance Commercial	$21.87

FLUCONAZOLE 100 MG TABLET [10044]

Facility

$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: Kaiser Permanente Commercial	$27.00
Rate for Payer: MDX Hawaii PPO	$29.10

FLUCONAZOLE 10 MG/ML ORAL SUSPENSION [14232]

Facility

$90.00

Service Code	NDC 57237014935
Hospital Revenue Code	637
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$87.30
Rate for Payer: AlohaCare Medicaid	$45.00
Rate for Payer: AlohaCare Medicare	$27.90
Rate for Payer: Cash Price	$54.00
Rate for Payer: Devoted Health Medicare	$30.60
Rate for Payer: Hawaii Medical Service Association Medicare	$27.90
Rate for Payer: Hawaii Western Management Group Commercial	$85.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Humana Medicare	$27.90
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: Kaiser Permanente Medicare	$27.90
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: Ohana Health Plan Medicaid	$27.90
Rate for Payer: Ohana Health Plan Medicare	$27.90
Rate for Payer: UnitedHealthcare Medicare	$27.90
Rate for Payer: University Health Alliance Commercial	$65.60

FLUCONAZOLE 10 MG/ML ORAL SUSPENSION [14232]

Facility

$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: Kaiser Permanente Commercial	$81.00
Rate for Payer: MDX Hawaii PPO	$87.30

FLUCONAZOLE 150 MG TABLET [13577]

Facility

$36.00

Service Code	NDC 68001025317
Hospital Revenue Code	637
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$34.92
Rate for Payer: AlohaCare Medicaid	$18.00
Rate for Payer: AlohaCare Medicare	$11.16
Rate for Payer: Cash Price	$21.60
Rate for Payer: Devoted Health Medicare	$12.24
Rate for Payer: Hawaii Medical Service Association Medicare	$11.16
Rate for Payer: Hawaii Western Management Group Commercial	$34.20
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Humana Medicare	$11.16
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: Kaiser Permanente Medicare	$11.16
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: Ohana Health Plan Medicaid	$11.16
Rate for Payer: Ohana Health Plan Medicare	$11.16
Rate for Payer: UnitedHealthcare Medicare	$11.16
Rate for Payer: University Health Alliance Commercial	$26.24

FLUCONAZOLE 150 MG TABLET [13577]

Facility

$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: Kaiser Permanente Commercial	$32.40
Rate for Payer: MDX Hawaii PPO	$34.92

FLUCONAZOLE 150 MG TABLET [13577]

Facility

$36.00

Service Code	NDC 68001025344
Hospital Revenue Code	637
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$34.92
Rate for Payer: AlohaCare Medicaid	$18.00
Rate for Payer: AlohaCare Medicare	$11.16
Rate for Payer: Cash Price	$21.60
Rate for Payer: Devoted Health Medicare	$12.24
Rate for Payer: Hawaii Medical Service Association Medicare	$11.16
Rate for Payer: Hawaii Western Management Group Commercial	$34.20
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Humana Medicare	$11.16
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: Kaiser Permanente Medicare	$11.16
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: Ohana Health Plan Medicaid	$11.16
Rate for Payer: Ohana Health Plan Medicare	$11.16
Rate for Payer: UnitedHealthcare Medicare	$11.16
Rate for Payer: University Health Alliance Commercial	$26.24

FLUCONAZOLE 150 MG TABLET [13577]

Facility

$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: Kaiser Permanente Commercial	$32.40
Rate for Payer: MDX Hawaii PPO	$34.92

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

Facility

$38.00

Service Code	HCPCS J1450
Hospital Revenue Code	636
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$36.86
Rate for Payer: AlohaCare Medicaid	$19.00
Rate for Payer: AlohaCare Medicare	$11.78
Rate for Payer: Cash Price	$22.80
Rate for Payer: Cash Price	$22.80
Rate for Payer: Devoted Health Medicare	$12.92
Rate for Payer: Hawaii Medical Service Association ABD	$2.26
Rate for Payer: Hawaii Medical Service Association Medicare	$11.78
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: Humana Medicare	$11.78
Rate for Payer: Kaiser Permanente Commercial	$34.20
Rate for Payer: Kaiser Permanente Medicaid	$19.38
Rate for Payer: Kaiser Permanente Medicare	$11.78
Rate for Payer: MDX Hawaii PPO	$36.86
Rate for Payer: Ohana Health Plan Medicaid	$11.78
Rate for Payer: Ohana Health Plan Medicare	$11.78
Rate for Payer: UnitedHealthcare Medicaid	$22.80
Rate for Payer: UnitedHealthcare Medicare	$11.78
Rate for Payer: University Health Alliance Commercial	$27.70

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

Facility

$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: Kaiser Permanente Commercial	$34.20
Rate for Payer: MDX Hawaii PPO	$36.86

FLUCONAZOLE 200 MG TABLET [10045]

Facility

$110.00

Service Code	NDC 68084073501
Hospital Revenue Code	637
Min. Negotiated Rate	$34.10
Max. Negotiated Rate	$106.70
Rate for Payer: AlohaCare Medicaid	$55.00
Rate for Payer: AlohaCare Medicare	$34.10
Rate for Payer: Cash Price	$66.00
Rate for Payer: Devoted Health Medicare	$37.40
Rate for Payer: Hawaii Medical Service Association Medicare	$34.10
Rate for Payer: Hawaii Western Management Group Commercial	$104.50
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: Humana Medicare	$34.10
Rate for Payer: Kaiser Permanente Commercial	$99.00
Rate for Payer: Kaiser Permanente Medicaid	$56.10
Rate for Payer: Kaiser Permanente Medicare	$34.10
Rate for Payer: MDX Hawaii PPO	$106.70
Rate for Payer: Ohana Health Plan Medicaid	$34.10
Rate for Payer: Ohana Health Plan Medicare	$34.10
Rate for Payer: UnitedHealthcare Medicare	$34.10
Rate for Payer: University Health Alliance Commercial	$80.18

FLUCONAZOLE 200 MG TABLET [10045]

Facility

$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: Kaiser Permanente Commercial	$99.00
Rate for Payer: MDX Hawaii PPO	$106.70

FLUCONAZOLE 200 MG TABLET [10045]

Facility

$110.00

Service Code	NDC 68084073511
Hospital Revenue Code	637
Min. Negotiated Rate	$34.10
Max. Negotiated Rate	$106.70
Rate for Payer: AlohaCare Medicaid	$55.00
Rate for Payer: AlohaCare Medicare	$34.10
Rate for Payer: Cash Price	$66.00
Rate for Payer: Devoted Health Medicare	$37.40
Rate for Payer: Hawaii Medical Service Association Medicare	$34.10
Rate for Payer: Hawaii Western Management Group Commercial	$104.50
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: Humana Medicare	$34.10
Rate for Payer: Kaiser Permanente Commercial	$99.00
Rate for Payer: Kaiser Permanente Medicaid	$56.10
Rate for Payer: Kaiser Permanente Medicare	$34.10
Rate for Payer: MDX Hawaii PPO	$106.70
Rate for Payer: Ohana Health Plan Medicaid	$34.10
Rate for Payer: Ohana Health Plan Medicare	$34.10
Rate for Payer: UnitedHealthcare Medicare	$34.10
Rate for Payer: University Health Alliance Commercial	$80.18

Know your out-of-pocket cost for care.

All Charges