Kau Hospital

All Charges

Charge

Type

Setting

Price

FLUORESCEIN 1 MG EYE STRIPS [27663]

Facility

$1.00

Service Code	NDC 17238090011
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	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

$1.00

Service Code	NDC 17238090011
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

$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

FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION [137870]

Facility

$150.00

Service Code	HCPCS J3490
Hospital Revenue Code	250
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: MDX Hawaii PPO	$145.50

FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION [137870]

Facility

$150.00

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$75.00
Rate for Payer: AlohaCare Medicare	$46.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Devoted Health Medicare	$51.00
Rate for Payer: Hawaii Medical Service Association Medicare	$46.50
Rate for Payer: Hawaii Western Management Group Commercial	$142.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$46.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$46.50
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$46.50
Rate for Payer: Ohana Health Plan Medicare	$46.50
Rate for Payer: UnitedHealthcare Medicaid	$90.00
Rate for Payer: UnitedHealthcare Medicare	$46.50
Rate for Payer: University Health Alliance Commercial	$109.33

FLUOROURACIL 1 GRAM/20 ML INTRAVENOUS SOLUTION [82204]

Facility

$29.00

Service Code	HCPCS J9190
Hospital Revenue Code	636
Min. Negotiated Rate	$1.72
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: Cash Price	$17.40
Rate for Payer: Devoted Health Medicare	$9.86
Rate for Payer: Hawaii Medical Service Association ABD	$1.72
Rate for Payer: Hawaii Medical Service Association Medicare	$8.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.72
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 Medicaid	$17.40
Rate for Payer: UnitedHealthcare Medicare	$8.99
Rate for Payer: University Health Alliance Commercial	$21.14

FLUOROURACIL 1 GRAM/20 ML INTRAVENOUS SOLUTION [82204]

Facility

$29.00

Service Code	HCPCS J9190
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

FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION [82180]

Facility

$62.00

Service Code	HCPCS J9190
Hospital Revenue Code	250
Min. Negotiated Rate	$52.70
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$37.20
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Kaiser Permanente Commercial	$55.80
Rate for Payer: MDX Hawaii PPO	$60.14

FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION [82180]

Facility

$62.00

Service Code	HCPCS J9190
Hospital Revenue Code	636
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$60.14
Rate for Payer: AlohaCare Medicaid	$31.00
Rate for Payer: AlohaCare Medicare	$19.22
Rate for Payer: Cash Price	$37.20
Rate for Payer: Cash Price	$37.20
Rate for Payer: Devoted Health Medicare	$21.08
Rate for Payer: Hawaii Medical Service Association ABD	$1.72
Rate for Payer: Hawaii Medical Service Association Medicare	$19.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.72
Rate for Payer: Hawaii Western Management Group Commercial	$58.90
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Humana Medicare	$19.22
Rate for Payer: Kaiser Permanente Commercial	$55.80
Rate for Payer: Kaiser Permanente Medicaid	$31.62
Rate for Payer: Kaiser Permanente Medicare	$19.22
Rate for Payer: MDX Hawaii PPO	$60.14
Rate for Payer: Ohana Health Plan Medicaid	$19.22
Rate for Payer: Ohana Health Plan Medicare	$19.22
Rate for Payer: UnitedHealthcare Medicaid	$37.20
Rate for Payer: UnitedHealthcare Medicare	$19.22
Rate for Payer: University Health Alliance Commercial	$45.19

FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION [82200]

Facility

$15.00

Service Code	HCPCS J9190
Hospital Revenue Code	636
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$4.65
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$5.10
Rate for Payer: Hawaii Medical Service Association ABD	$1.72
Rate for Payer: Hawaii Medical Service Association Medicare	$4.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.72
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$4.65
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$4.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$4.65
Rate for Payer: Ohana Health Plan Medicare	$4.65
Rate for Payer: UnitedHealthcare Medicaid	$9.00
Rate for Payer: UnitedHealthcare Medicare	$4.65
Rate for Payer: University Health Alliance Commercial	$10.93

FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION [82200]

Facility

$15.00

Service Code	HCPCS J9190
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION [98249]

Facility

$124.00

Service Code	HCPCS J9190
Hospital Revenue Code	636
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$120.28
Rate for Payer: AlohaCare Medicaid	$62.00
Rate for Payer: AlohaCare Medicaid	$49.50
Rate for Payer: AlohaCare Medicaid	$12.50
Rate for Payer: AlohaCare Medicare	$7.75
Rate for Payer: AlohaCare Medicare	$38.44
Rate for Payer: AlohaCare Medicare	$30.69
Rate for Payer: Cash Price	$15.00
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cash Price	$15.00
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cash Price	$59.40
Rate for Payer: Devoted Health Medicare	$42.16
Rate for Payer: Devoted Health Medicare	$33.66
Rate for Payer: Devoted Health Medicare	$8.50
Rate for Payer: Hawaii Medical Service Association ABD	$1.72
Rate for Payer: Hawaii Medical Service Association ABD	$1.72
Rate for Payer: Hawaii Medical Service Association ABD	$1.72
Rate for Payer: Hawaii Medical Service Association Medicare	$38.44
Rate for Payer: Hawaii Medical Service Association Medicare	$30.69
Rate for Payer: Hawaii Medical Service Association Medicare	$7.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.72
Rate for Payer: Hawaii Western Management Group Commercial	$23.75
Rate for Payer: Hawaii Western Management Group Commercial	$117.80
Rate for Payer: Hawaii Western Management Group Commercial	$94.05
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Humana Medicare	$38.44
Rate for Payer: Humana Medicare	$7.75
Rate for Payer: Humana Medicare	$30.69
Rate for Payer: Kaiser Permanente Commercial	$111.60
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: Kaiser Permanente Commercial	$89.10
Rate for Payer: Kaiser Permanente Medicaid	$50.49
Rate for Payer: Kaiser Permanente Medicaid	$12.75
Rate for Payer: Kaiser Permanente Medicaid	$63.24
Rate for Payer: Kaiser Permanente Medicare	$38.44
Rate for Payer: Kaiser Permanente Medicare	$7.75
Rate for Payer: Kaiser Permanente Medicare	$30.69
Rate for Payer: MDX Hawaii PPO	$96.03
Rate for Payer: MDX Hawaii PPO	$24.25
Rate for Payer: MDX Hawaii PPO	$120.28
Rate for Payer: Ohana Health Plan Medicaid	$7.75
Rate for Payer: Ohana Health Plan Medicaid	$38.44
Rate for Payer: Ohana Health Plan Medicaid	$30.69
Rate for Payer: Ohana Health Plan Medicare	$7.75
Rate for Payer: Ohana Health Plan Medicare	$38.44
Rate for Payer: Ohana Health Plan Medicare	$30.69
Rate for Payer: UnitedHealthcare Medicaid	$15.00
Rate for Payer: UnitedHealthcare Medicaid	$74.40
Rate for Payer: UnitedHealthcare Medicaid	$59.40
Rate for Payer: UnitedHealthcare Medicare	$7.75
Rate for Payer: UnitedHealthcare Medicare	$38.44
Rate for Payer: UnitedHealthcare Medicare	$30.69
Rate for Payer: University Health Alliance Commercial	$90.38
Rate for Payer: University Health Alliance Commercial	$18.22
Rate for Payer: University Health Alliance Commercial	$72.16

FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION [98249]

Facility

$99.00

Service Code	HCPCS J9190
Hospital Revenue Code	250
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cash Price	$15.00
Rate for Payer: Cash Price	$74.40
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: Kaiser Permanente Commercial	$89.10
Rate for Payer: Kaiser Permanente Commercial	$111.60
Rate for Payer: MDX Hawaii PPO	$24.25
Rate for Payer: MDX Hawaii PPO	$120.28
Rate for Payer: MDX Hawaii PPO	$96.03

FLUOXETINE 10 MG CAPSULE [10069]

Facility

$1.00

Service Code	NDC 00904734561
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

FLUOXETINE 10 MG CAPSULE [10069]

Facility

$10.00

Service Code	NDC 68001039900
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: MDX Hawaii PPO	$9.70

FLUOXETINE 10 MG CAPSULE [10069]

Facility

$10.00

Service Code	NDC 68001039900
Hospital Revenue Code	637
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$9.70
Rate for Payer: AlohaCare Medicaid	$5.00
Rate for Payer: AlohaCare Medicare	$3.10
Rate for Payer: Cash Price	$6.00
Rate for Payer: Devoted Health Medicare	$3.40
Rate for Payer: Hawaii Medical Service Association Medicare	$3.10
Rate for Payer: Hawaii Western Management Group Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Humana Medicare	$3.10
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: Kaiser Permanente Medicaid	$5.10
Rate for Payer: Kaiser Permanente Medicare	$3.10
Rate for Payer: MDX Hawaii PPO	$9.70
Rate for Payer: Ohana Health Plan Medicaid	$3.10
Rate for Payer: Ohana Health Plan Medicare	$3.10
Rate for Payer: UnitedHealthcare Medicare	$3.10
Rate for Payer: University Health Alliance Commercial	$7.29

FLUOXETINE 10 MG CAPSULE [10069]

Facility

$1.00

Service Code	NDC 00904734561
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

FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION [38488]

Facility

$177.00

Service Code	NDC 00832603212
Hospital Revenue Code	637
Min. Negotiated Rate	$54.87
Max. Negotiated Rate	$171.69
Rate for Payer: AlohaCare Medicaid	$88.50
Rate for Payer: AlohaCare Medicare	$54.87
Rate for Payer: Cash Price	$106.20
Rate for Payer: Devoted Health Medicare	$60.18
Rate for Payer: Hawaii Medical Service Association Medicare	$54.87
Rate for Payer: Hawaii Western Management Group Commercial	$168.15
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Humana Medicare	$54.87
Rate for Payer: Kaiser Permanente Commercial	$159.30
Rate for Payer: Kaiser Permanente Medicaid	$90.27
Rate for Payer: Kaiser Permanente Medicare	$54.87
Rate for Payer: MDX Hawaii PPO	$171.69
Rate for Payer: Ohana Health Plan Medicaid	$54.87
Rate for Payer: Ohana Health Plan Medicare	$54.87
Rate for Payer: UnitedHealthcare Medicare	$54.87
Rate for Payer: University Health Alliance Commercial	$129.02

FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION [38488]

Facility

$177.00

Service Code	NDC 00121072104
Hospital Revenue Code	637
Min. Negotiated Rate	$54.87
Max. Negotiated Rate	$171.69
Rate for Payer: AlohaCare Medicaid	$88.50
Rate for Payer: AlohaCare Medicare	$54.87
Rate for Payer: Cash Price	$106.20
Rate for Payer: Devoted Health Medicare	$60.18
Rate for Payer: Hawaii Medical Service Association Medicare	$54.87
Rate for Payer: Hawaii Western Management Group Commercial	$168.15
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Humana Medicare	$54.87
Rate for Payer: Kaiser Permanente Commercial	$159.30
Rate for Payer: Kaiser Permanente Medicaid	$90.27
Rate for Payer: Kaiser Permanente Medicare	$54.87
Rate for Payer: MDX Hawaii PPO	$171.69
Rate for Payer: Ohana Health Plan Medicaid	$54.87
Rate for Payer: Ohana Health Plan Medicare	$54.87
Rate for Payer: UnitedHealthcare Medicare	$54.87
Rate for Payer: University Health Alliance Commercial	$129.02

FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION [38488]

Facility

$177.00

Service Code	NDC 00832603212
Hospital Revenue Code	250
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$106.20
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Kaiser Permanente Commercial	$159.30
Rate for Payer: MDX Hawaii PPO	$171.69

FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION [38488]

Facility

$177.00

Service Code	NDC 54838052340
Hospital Revenue Code	637
Min. Negotiated Rate	$54.87
Max. Negotiated Rate	$171.69
Rate for Payer: AlohaCare Medicaid	$88.50
Rate for Payer: AlohaCare Medicare	$54.87
Rate for Payer: Cash Price	$106.20
Rate for Payer: Devoted Health Medicare	$60.18
Rate for Payer: Hawaii Medical Service Association Medicare	$54.87
Rate for Payer: Hawaii Western Management Group Commercial	$168.15
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Humana Medicare	$54.87
Rate for Payer: Kaiser Permanente Commercial	$159.30
Rate for Payer: Kaiser Permanente Medicaid	$90.27
Rate for Payer: Kaiser Permanente Medicare	$54.87
Rate for Payer: MDX Hawaii PPO	$171.69
Rate for Payer: Ohana Health Plan Medicaid	$54.87
Rate for Payer: Ohana Health Plan Medicare	$54.87
Rate for Payer: UnitedHealthcare Medicare	$54.87
Rate for Payer: University Health Alliance Commercial	$129.02

FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION [38488]

Facility

$177.00

Service Code	NDC 54838052340
Hospital Revenue Code	250
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$106.20
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Kaiser Permanente Commercial	$159.30
Rate for Payer: MDX Hawaii PPO	$171.69

FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION [38488]

Facility

$177.00

Service Code	NDC 00121072104
Hospital Revenue Code	250
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$106.20
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Kaiser Permanente Commercial	$159.30
Rate for Payer: MDX Hawaii PPO	$171.69

FLUOXETINE 20 MG CAPSULE [10070]

Facility

$1.00

Service Code	NDC 00904734661
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

Know your out-of-pocket cost for care.

All Charges