Kau Hospital

All Charges

Charge

Type

Setting

Price

FLUCONAZOLE 200 MG TABLET [10045]

Facility

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

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

Facility

$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: Kaiser Permanente Commercial	$53.10
Rate for Payer: MDX Hawaii PPO	$57.23

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

Facility

$59.00

Service Code	HCPCS J1450
Hospital Revenue Code	636
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$57.23
Rate for Payer: AlohaCare Medicaid	$29.50
Rate for Payer: AlohaCare Medicare	$18.29
Rate for Payer: Cash Price	$35.40
Rate for Payer: Cash Price	$35.40
Rate for Payer: Devoted Health Medicare	$20.06
Rate for Payer: Hawaii Medical Service Association ABD	$2.26
Rate for Payer: Hawaii Medical Service Association Medicare	$18.29
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: Humana Medicare	$18.29
Rate for Payer: Kaiser Permanente Commercial	$53.10
Rate for Payer: Kaiser Permanente Medicaid	$30.09
Rate for Payer: Kaiser Permanente Medicare	$18.29
Rate for Payer: MDX Hawaii PPO	$57.23
Rate for Payer: Ohana Health Plan Medicaid	$18.29
Rate for Payer: Ohana Health Plan Medicare	$18.29
Rate for Payer: UnitedHealthcare Medicaid	$35.40
Rate for Payer: UnitedHealthcare Medicare	$18.29
Rate for Payer: University Health Alliance Commercial	$43.01

FLUCONAZOLE 40 MG/ML ORAL SUSPENSION [14233]

Facility

$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

$195.00

Service Code	NDC 70436022748
Hospital Revenue Code	637
Min. Negotiated Rate	$60.45
Max. Negotiated Rate	$189.15
Rate for Payer: AlohaCare Medicaid	$97.50
Rate for Payer: AlohaCare Medicare	$60.45
Rate for Payer: Cash Price	$117.00
Rate for Payer: Devoted Health Medicare	$66.30
Rate for Payer: Hawaii Medical Service Association Medicare	$60.45
Rate for Payer: Hawaii Western Management Group Commercial	$185.25
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Humana Medicare	$60.45
Rate for Payer: Kaiser Permanente Commercial	$175.50
Rate for Payer: Kaiser Permanente Medicaid	$99.45
Rate for Payer: Kaiser Permanente Medicare	$60.45
Rate for Payer: MDX Hawaii PPO	$189.15
Rate for Payer: Ohana Health Plan Medicaid	$60.45
Rate for Payer: Ohana Health Plan Medicare	$60.45
Rate for Payer: UnitedHealthcare Medicare	$60.45
Rate for Payer: University Health Alliance Commercial	$142.14

FLUCONAZOLE 40 MG/ML ORAL SUSPENSION [14233]

Facility

$196.00

Service Code	NDC 57237015035
Hospital Revenue Code	637
Min. Negotiated Rate	$60.76
Max. Negotiated Rate	$190.12
Rate for Payer: AlohaCare Medicaid	$98.00
Rate for Payer: AlohaCare Medicare	$60.76
Rate for Payer: Cash Price	$117.60
Rate for Payer: Devoted Health Medicare	$66.64
Rate for Payer: Hawaii Medical Service Association Medicare	$60.76
Rate for Payer: Hawaii Western Management Group Commercial	$186.20
Rate for Payer: Health Management Network Commercial	$166.60
Rate for Payer: Humana Medicare	$60.76
Rate for Payer: Kaiser Permanente Commercial	$176.40
Rate for Payer: Kaiser Permanente Medicaid	$99.96
Rate for Payer: Kaiser Permanente Medicare	$60.76
Rate for Payer: MDX Hawaii PPO	$190.12
Rate for Payer: Ohana Health Plan Medicaid	$60.76
Rate for Payer: Ohana Health Plan Medicare	$60.76
Rate for Payer: UnitedHealthcare Medicare	$60.76
Rate for Payer: University Health Alliance Commercial	$142.86

FLUCONAZOLE 40 MG/ML ORAL SUSPENSION [14233]

Facility

$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

FLUCYTOSINE 500 MG CAPSULE [10052]

Facility

$229.00

Service Code	NDC 00904683507
Hospital Revenue Code	637
Min. Negotiated Rate	$70.99
Max. Negotiated Rate	$222.13
Rate for Payer: AlohaCare Medicaid	$114.50
Rate for Payer: AlohaCare Medicare	$70.99
Rate for Payer: Cash Price	$137.40
Rate for Payer: Devoted Health Medicare	$77.86
Rate for Payer: Hawaii Medical Service Association Medicare	$70.99
Rate for Payer: Hawaii Western Management Group Commercial	$217.55
Rate for Payer: Health Management Network Commercial	$194.65
Rate for Payer: Humana Medicare	$70.99
Rate for Payer: Kaiser Permanente Commercial	$206.10
Rate for Payer: Kaiser Permanente Medicaid	$116.79
Rate for Payer: Kaiser Permanente Medicare	$70.99
Rate for Payer: MDX Hawaii PPO	$222.13
Rate for Payer: Ohana Health Plan Medicaid	$70.99
Rate for Payer: Ohana Health Plan Medicare	$70.99
Rate for Payer: UnitedHealthcare Medicare	$70.99
Rate for Payer: University Health Alliance Commercial	$166.92

FLUCYTOSINE 500 MG CAPSULE [10052]

Facility

$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

$283.00

Service Code	NDC 60687061011
Hospital Revenue Code	637
Min. Negotiated Rate	$87.73
Max. Negotiated Rate	$274.51
Rate for Payer: AlohaCare Medicaid	$141.50
Rate for Payer: AlohaCare Medicare	$87.73
Rate for Payer: Cash Price	$169.80
Rate for Payer: Devoted Health Medicare	$96.22
Rate for Payer: Hawaii Medical Service Association Medicare	$87.73
Rate for Payer: Hawaii Western Management Group Commercial	$268.85
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Humana Medicare	$87.73
Rate for Payer: Kaiser Permanente Commercial	$254.70
Rate for Payer: Kaiser Permanente Medicaid	$144.33
Rate for Payer: Kaiser Permanente Medicare	$87.73
Rate for Payer: MDX Hawaii PPO	$274.51
Rate for Payer: Ohana Health Plan Medicaid	$87.73
Rate for Payer: Ohana Health Plan Medicare	$87.73
Rate for Payer: UnitedHealthcare Medicare	$87.73
Rate for Payer: University Health Alliance Commercial	$206.28

FLUCYTOSINE 500 MG CAPSULE [10052]

Facility

$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

$283.00

Service Code	NDC 60687061021
Hospital Revenue Code	637
Min. Negotiated Rate	$87.73
Max. Negotiated Rate	$274.51
Rate for Payer: AlohaCare Medicaid	$141.50
Rate for Payer: AlohaCare Medicare	$87.73
Rate for Payer: Cash Price	$169.80
Rate for Payer: Devoted Health Medicare	$96.22
Rate for Payer: Hawaii Medical Service Association Medicare	$87.73
Rate for Payer: Hawaii Western Management Group Commercial	$268.85
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Humana Medicare	$87.73
Rate for Payer: Kaiser Permanente Commercial	$254.70
Rate for Payer: Kaiser Permanente Medicaid	$144.33
Rate for Payer: Kaiser Permanente Medicare	$87.73
Rate for Payer: MDX Hawaii PPO	$274.51
Rate for Payer: Ohana Health Plan Medicaid	$87.73
Rate for Payer: Ohana Health Plan Medicare	$87.73
Rate for Payer: UnitedHealthcare Medicare	$87.73
Rate for Payer: University Health Alliance Commercial	$206.28

FLUCYTOSINE 500 MG CAPSULE [10052]

Facility

$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

FLUDROCORTISONE 0.1 MG TABLET [10054]

Facility

$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

$6.00

Service Code	NDC 50268033011
Hospital Revenue Code	637
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$1.86
Rate for Payer: Cash Price	$3.60
Rate for Payer: Devoted Health Medicare	$2.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1.86
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$1.86
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$1.86
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$1.86
Rate for Payer: Ohana Health Plan Medicare	$1.86
Rate for Payer: UnitedHealthcare Medicare	$1.86
Rate for Payer: University Health Alliance Commercial	$4.37

FLUDROCORTISONE 0.1 MG TABLET [10054]

Facility

$4.00

Service Code	NDC 68084028801
Hospital Revenue Code	637
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$1.24
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$1.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$1.24
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$1.24
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$1.24
Rate for Payer: Ohana Health Plan Medicare	$1.24
Rate for Payer: UnitedHealthcare Medicare	$1.24
Rate for Payer: University Health Alliance Commercial	$2.92

FLUDROCORTISONE 0.1 MG TABLET [10054]

Facility

$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

FLUDROCORTISONE 0.1 MG TABLET [10054]

Facility

$6.00

Service Code	NDC 50268033015
Hospital Revenue Code	637
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$1.86
Rate for Payer: Cash Price	$3.60
Rate for Payer: Devoted Health Medicare	$2.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1.86
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$1.86
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$1.86
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$1.86
Rate for Payer: Ohana Health Plan Medicare	$1.86
Rate for Payer: UnitedHealthcare Medicare	$1.86
Rate for Payer: University Health Alliance Commercial	$4.37

FLUDROCORTISONE 0.1 MG TABLET [10054]

Facility

$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

FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [39744]

Facility

$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

$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

$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

$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

$1.00

Service Code	NDC 17238090030
Hospital Revenue Code	637
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.31
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.34
Rate for Payer: Hawaii Medical Service Association Medicare	$0.31
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.31
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.31
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.31
Rate for Payer: Ohana Health Plan Medicare	$0.31
Rate for Payer: UnitedHealthcare Medicare	$0.31
Rate for Payer: University Health Alliance Commercial	$0.73

FLUORESCEIN 1 MG EYE STRIPS [27663]

Facility

$1.00

Service Code	NDC 17238090099
Hospital Revenue Code	637
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.31
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.34
Rate for Payer: Hawaii Medical Service Association Medicare	$0.31
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.31
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.31
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.31
Rate for Payer: Ohana Health Plan Medicare	$0.31
Rate for Payer: UnitedHealthcare Medicare	$0.31
Rate for Payer: University Health Alliance Commercial	$0.73

Know your out-of-pocket cost for care.

All Charges