Kohala Hospital

All Charges

Charge

Type

Setting

Price

FLUCONAZOLE 200 MG PO TABLET

Facility

$200.16

Service Code	NDC 68084073511
Hospital Revenue Code	637
Min. Negotiated Rate	$100.08
Max. Negotiated Rate	$198.16
Rate for Payer: AlohaCare Medicaid	$100.08
Rate for Payer: AlohaCare Medicare	$180.14
Rate for Payer: Cash Price	$130.10
Rate for Payer: Devoted Health Medicare	$198.16
Rate for Payer: Hawaii Medical Service Association Medicare	$180.14
Rate for Payer: Hawaii Western Management Group Commercial	$190.15
Rate for Payer: Health Management Network Commercial	$170.14
Rate for Payer: Humana Medicare	$180.14
Rate for Payer: Kaiser Permanente Commercial	$180.14
Rate for Payer: Kaiser Permanente Medicaid	$102.08
Rate for Payer: Kaiser Permanente Medicare	$180.14
Rate for Payer: MDX Hawaii PPO	$194.16
Rate for Payer: Ohana Health Plan Medicaid	$180.14
Rate for Payer: Ohana Health Plan Medicare	$180.14
Rate for Payer: UnitedHealthcare Medicare	$180.14
Rate for Payer: University Health Alliance Commercial	$145.90

FLUCONAZOLE IN NORMAL SALINE 200 MG/100 ML IV IVPB (PREMIX)

Facility

$53.13

Service Code	HCPCS J1450
Hospital Revenue Code	250
Min. Negotiated Rate	$45.16
Max. Negotiated Rate	$51.54
Rate for Payer: Cash Price	$34.53
Rate for Payer: Health Management Network Commercial	$45.16
Rate for Payer: Kaiser Permanente Commercial	$47.82
Rate for Payer: MDX Hawaii PPO	$51.54

FLUCONAZOLE IN NORMAL SALINE 200 MG/100 ML IV IVPB (PREMIX)

Facility

$53.13

Service Code	HCPCS J1450
Hospital Revenue Code	636
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$52.60
Rate for Payer: AlohaCare Medicaid	$26.57
Rate for Payer: AlohaCare Medicare	$47.82
Rate for Payer: Cash Price	$34.53
Rate for Payer: Cash Price	$34.53
Rate for Payer: Devoted Health Medicare	$52.60
Rate for Payer: Hawaii Medical Service Association ABD	$2.26
Rate for Payer: Hawaii Medical Service Association Medicare	$47.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.26
Rate for Payer: Hawaii Western Management Group Commercial	$50.47
Rate for Payer: Health Management Network Commercial	$45.16
Rate for Payer: Humana Medicare	$47.82
Rate for Payer: Kaiser Permanente Commercial	$47.82
Rate for Payer: Kaiser Permanente Medicaid	$27.10
Rate for Payer: Kaiser Permanente Medicare	$47.82
Rate for Payer: MDX Hawaii PPO	$51.54
Rate for Payer: Ohana Health Plan Medicaid	$47.82
Rate for Payer: Ohana Health Plan Medicare	$47.82
Rate for Payer: UnitedHealthcare Medicaid	$31.88
Rate for Payer: UnitedHealthcare Medicare	$47.82
Rate for Payer: University Health Alliance Commercial	$38.73

FLUDROCORTISONE 0.1 MG PO TABLET

Facility

$8.83

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$8.57
Rate for Payer: Cash Price	$5.74
Rate for Payer: Health Management Network Commercial	$7.51
Rate for Payer: Kaiser Permanente Commercial	$7.95
Rate for Payer: MDX Hawaii PPO	$8.57

FLUDROCORTISONE 0.1 MG PO TABLET

Facility

$8.83

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$8.74
Rate for Payer: AlohaCare Medicaid	$4.42
Rate for Payer: AlohaCare Medicare	$7.95
Rate for Payer: Cash Price	$5.74
Rate for Payer: Devoted Health Medicare	$8.74
Rate for Payer: Hawaii Medical Service Association Medicare	$7.95
Rate for Payer: Hawaii Western Management Group Commercial	$8.39
Rate for Payer: Health Management Network Commercial	$7.51
Rate for Payer: Humana Medicare	$7.95
Rate for Payer: Kaiser Permanente Commercial	$7.95
Rate for Payer: Kaiser Permanente Medicaid	$4.50
Rate for Payer: Kaiser Permanente Medicare	$7.95
Rate for Payer: MDX Hawaii PPO	$8.57
Rate for Payer: Ohana Health Plan Medicaid	$7.95
Rate for Payer: Ohana Health Plan Medicare	$7.95
Rate for Payer: UnitedHealthcare Medicare	$7.95
Rate for Payer: University Health Alliance Commercial	$6.44

FLUMAZENIL 0.1 MG/ML IV SOLN 5 ML VIAL

Facility

$43.87

Service Code	NDC 36000014801
Hospital Revenue Code	250
Min. Negotiated Rate	$21.93
Max. Negotiated Rate	$43.43
Rate for Payer: AlohaCare Medicaid	$21.93
Rate for Payer: AlohaCare Medicare	$39.48
Rate for Payer: Cash Price	$28.52
Rate for Payer: Devoted Health Medicare	$43.43
Rate for Payer: Hawaii Medical Service Association Medicare	$39.48
Rate for Payer: Hawaii Western Management Group Commercial	$41.68
Rate for Payer: Health Management Network Commercial	$37.29
Rate for Payer: Humana Medicare	$39.48
Rate for Payer: Kaiser Permanente Commercial	$39.48
Rate for Payer: Kaiser Permanente Medicaid	$22.37
Rate for Payer: Kaiser Permanente Medicare	$39.48
Rate for Payer: MDX Hawaii PPO	$42.55
Rate for Payer: Ohana Health Plan Medicaid	$39.48
Rate for Payer: Ohana Health Plan Medicare	$39.48
Rate for Payer: UnitedHealthcare Medicaid	$26.32
Rate for Payer: UnitedHealthcare Medicare	$39.48
Rate for Payer: University Health Alliance Commercial	$31.98

FLUMAZENIL 0.1 MG/ML IV SOLN 5 ML VIAL

Facility

$43.87

Service Code	NDC 36000014810
Hospital Revenue Code	250
Min. Negotiated Rate	$21.93
Max. Negotiated Rate	$43.43
Rate for Payer: AlohaCare Medicaid	$21.93
Rate for Payer: AlohaCare Medicare	$39.48
Rate for Payer: Cash Price	$28.52
Rate for Payer: Devoted Health Medicare	$43.43
Rate for Payer: Hawaii Medical Service Association Medicare	$39.48
Rate for Payer: Hawaii Western Management Group Commercial	$41.68
Rate for Payer: Health Management Network Commercial	$37.29
Rate for Payer: Humana Medicare	$39.48
Rate for Payer: Kaiser Permanente Commercial	$39.48
Rate for Payer: Kaiser Permanente Medicaid	$22.37
Rate for Payer: Kaiser Permanente Medicare	$39.48
Rate for Payer: MDX Hawaii PPO	$42.55
Rate for Payer: Ohana Health Plan Medicaid	$39.48
Rate for Payer: Ohana Health Plan Medicare	$39.48
Rate for Payer: UnitedHealthcare Medicaid	$26.32
Rate for Payer: UnitedHealthcare Medicare	$39.48
Rate for Payer: University Health Alliance Commercial	$31.98

FLUMAZENIL 0.1 MG/ML IV SOLN 5 ML VIAL

Facility

$43.87

Service Code	NDC 36000014810
Hospital Revenue Code	250
Min. Negotiated Rate	$37.29
Max. Negotiated Rate	$42.55
Rate for Payer: Cash Price	$28.52
Rate for Payer: Health Management Network Commercial	$37.29
Rate for Payer: Kaiser Permanente Commercial	$39.48
Rate for Payer: MDX Hawaii PPO	$42.55

FLUMAZENIL 0.1 MG/ML IV SOLN 5 ML VIAL

Facility

$43.87

Service Code	NDC 36000014801
Hospital Revenue Code	250
Min. Negotiated Rate	$37.29
Max. Negotiated Rate	$42.55
Rate for Payer: Cash Price	$28.52
Rate for Payer: Health Management Network Commercial	$37.29
Rate for Payer: Kaiser Permanente Commercial	$39.48
Rate for Payer: MDX Hawaii PPO	$42.55

FLUORESCEIN 1 MG OPHT STRIP

Facility

$1.29

Service Code	NDC 83851010030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.28
Rate for Payer: AlohaCare Medicaid	$0.65
Rate for Payer: AlohaCare Medicare	$1.16
Rate for Payer: Cash Price	$0.84
Rate for Payer: Devoted Health Medicare	$1.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1.16
Rate for Payer: Hawaii Western Management Group Commercial	$1.23
Rate for Payer: Health Management Network Commercial	$1.10
Rate for Payer: Humana Medicare	$1.16
Rate for Payer: Kaiser Permanente Commercial	$1.16
Rate for Payer: Kaiser Permanente Medicaid	$0.66
Rate for Payer: Kaiser Permanente Medicare	$1.16
Rate for Payer: MDX Hawaii PPO	$1.25
Rate for Payer: Ohana Health Plan Medicaid	$1.16
Rate for Payer: Ohana Health Plan Medicare	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.77
Rate for Payer: UnitedHealthcare Medicare	$1.16
Rate for Payer: University Health Alliance Commercial	$0.94

FLUORESCEIN 1 MG OPHT STRIP

Facility

$1.29

Service Code	NDC 83851010030
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.25
Rate for Payer: Cash Price	$0.84
Rate for Payer: Health Management Network Commercial	$1.10
Rate for Payer: Kaiser Permanente Commercial	$1.16
Rate for Payer: MDX Hawaii PPO	$1.25

FLUORESCEIN 1 MG OPHT STRIP

Facility

$1.29

Service Code	NDC 83851010001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.28
Rate for Payer: AlohaCare Medicaid	$0.65
Rate for Payer: AlohaCare Medicare	$1.16
Rate for Payer: Cash Price	$0.84
Rate for Payer: Devoted Health Medicare	$1.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1.16
Rate for Payer: Hawaii Western Management Group Commercial	$1.23
Rate for Payer: Health Management Network Commercial	$1.10
Rate for Payer: Humana Medicare	$1.16
Rate for Payer: Kaiser Permanente Commercial	$1.16
Rate for Payer: Kaiser Permanente Medicaid	$0.66
Rate for Payer: Kaiser Permanente Medicare	$1.16
Rate for Payer: MDX Hawaii PPO	$1.25
Rate for Payer: Ohana Health Plan Medicaid	$1.16
Rate for Payer: Ohana Health Plan Medicare	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.77
Rate for Payer: UnitedHealthcare Medicare	$1.16
Rate for Payer: University Health Alliance Commercial	$0.94

FLUORESCEIN 1 MG OPHT STRIP

Facility

$1.46

Service Code	NDC 17238090099
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$1.45
Rate for Payer: AlohaCare Medicaid	$0.73
Rate for Payer: AlohaCare Medicare	$1.31
Rate for Payer: Cash Price	$0.95
Rate for Payer: Devoted Health Medicare	$1.45
Rate for Payer: Hawaii Medical Service Association Medicare	$1.31
Rate for Payer: Hawaii Western Management Group Commercial	$1.39
Rate for Payer: Health Management Network Commercial	$1.24
Rate for Payer: Humana Medicare	$1.31
Rate for Payer: Kaiser Permanente Commercial	$1.31
Rate for Payer: Kaiser Permanente Medicaid	$0.74
Rate for Payer: Kaiser Permanente Medicare	$1.31
Rate for Payer: MDX Hawaii PPO	$1.42
Rate for Payer: Ohana Health Plan Medicaid	$1.31
Rate for Payer: Ohana Health Plan Medicare	$1.31
Rate for Payer: UnitedHealthcare Medicaid	$0.88
Rate for Payer: UnitedHealthcare Medicare	$1.31
Rate for Payer: University Health Alliance Commercial	$1.06

FLUORESCEIN 1 MG OPHT STRIP

Facility

$1.46

Service Code	NDC 17238090099
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.42
Rate for Payer: Cash Price	$0.95
Rate for Payer: Health Management Network Commercial	$1.24
Rate for Payer: Kaiser Permanente Commercial	$1.31
Rate for Payer: MDX Hawaii PPO	$1.42

FLUORESCEIN 1 MG OPHT STRIP

Facility

$1.29

Service Code	NDC 83851010001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.25
Rate for Payer: Cash Price	$0.84
Rate for Payer: Health Management Network Commercial	$1.10
Rate for Payer: Kaiser Permanente Commercial	$1.16
Rate for Payer: MDX Hawaii PPO	$1.25

FLUOXETINE 10 MG PO CAP

Facility

$14.35

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$7.17
Max. Negotiated Rate	$14.21
Rate for Payer: AlohaCare Medicaid	$7.17
Rate for Payer: AlohaCare Medicare	$12.91
Rate for Payer: Cash Price	$9.33
Rate for Payer: Devoted Health Medicare	$14.21
Rate for Payer: Hawaii Medical Service Association Medicare	$12.91
Rate for Payer: Hawaii Western Management Group Commercial	$13.63
Rate for Payer: Health Management Network Commercial	$12.20
Rate for Payer: Humana Medicare	$12.91
Rate for Payer: Kaiser Permanente Commercial	$12.91
Rate for Payer: Kaiser Permanente Medicaid	$7.32
Rate for Payer: Kaiser Permanente Medicare	$12.91
Rate for Payer: MDX Hawaii PPO	$13.92
Rate for Payer: Ohana Health Plan Medicaid	$12.91
Rate for Payer: Ohana Health Plan Medicare	$12.91
Rate for Payer: UnitedHealthcare Medicare	$12.91
Rate for Payer: University Health Alliance Commercial	$10.46

FLUOXETINE 10 MG PO CAP

Facility

$14.35

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.20
Max. Negotiated Rate	$13.92
Rate for Payer: Cash Price	$9.33
Rate for Payer: Health Management Network Commercial	$12.20
Rate for Payer: Kaiser Permanente Commercial	$12.91
Rate for Payer: MDX Hawaii PPO	$13.92

FLUOXETINE 20 MG PO CAP

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.19
Rate for Payer: AlohaCare Medicaid	$0.60
Rate for Payer: AlohaCare Medicaid	$7.37
Rate for Payer: AlohaCare Medicare	$1.08
Rate for Payer: AlohaCare Medicare	$13.26
Rate for Payer: Cash Price	$9.57
Rate for Payer: Cash Price	$0.78
Rate for Payer: Devoted Health Medicare	$1.19
Rate for Payer: Devoted Health Medicare	$14.58
Rate for Payer: Hawaii Medical Service Association Medicare	$13.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.08
Rate for Payer: Hawaii Western Management Group Commercial	$13.99
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$12.52
Rate for Payer: Humana Medicare	$13.26
Rate for Payer: Humana Medicare	$1.08
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Commercial	$13.26
Rate for Payer: Kaiser Permanente Medicaid	$7.51
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicare	$13.26
Rate for Payer: Kaiser Permanente Medicare	$1.08
Rate for Payer: MDX Hawaii PPO	$14.29
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: Ohana Health Plan Medicaid	$1.08
Rate for Payer: Ohana Health Plan Medicaid	$13.26
Rate for Payer: Ohana Health Plan Medicare	$1.08
Rate for Payer: Ohana Health Plan Medicare	$13.26
Rate for Payer: UnitedHealthcare Medicare	$1.08
Rate for Payer: UnitedHealthcare Medicare	$13.26
Rate for Payer: University Health Alliance Commercial	$10.74
Rate for Payer: University Health Alliance Commercial	$0.87

FLUOXETINE 20 MG PO CAP

Facility

$14.73

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.52
Max. Negotiated Rate	$14.29
Rate for Payer: Cash Price	$9.57
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$12.52
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$13.26
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$14.29

FLUPHENAZINE HCL 5 MG PO TABLET

Facility

$54.10

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$45.98
Max. Negotiated Rate	$52.48
Rate for Payer: Cash Price	$35.16
Rate for Payer: Health Management Network Commercial	$45.98
Rate for Payer: Kaiser Permanente Commercial	$48.69
Rate for Payer: MDX Hawaii PPO	$52.48

FLUPHENAZINE HCL 5 MG PO TABLET

Facility

$54.10

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$27.05
Max. Negotiated Rate	$53.56
Rate for Payer: AlohaCare Medicaid	$27.05
Rate for Payer: AlohaCare Medicare	$48.69
Rate for Payer: Cash Price	$35.16
Rate for Payer: Devoted Health Medicare	$53.56
Rate for Payer: Hawaii Medical Service Association Medicare	$48.69
Rate for Payer: Hawaii Western Management Group Commercial	$51.40
Rate for Payer: Health Management Network Commercial	$45.98
Rate for Payer: Humana Medicare	$48.69
Rate for Payer: Kaiser Permanente Commercial	$48.69
Rate for Payer: Kaiser Permanente Medicaid	$27.59
Rate for Payer: Kaiser Permanente Medicare	$48.69
Rate for Payer: MDX Hawaii PPO	$52.48
Rate for Payer: Ohana Health Plan Medicaid	$48.69
Rate for Payer: Ohana Health Plan Medicare	$48.69
Rate for Payer: UnitedHealthcare Medicare	$48.69
Rate for Payer: University Health Alliance Commercial	$39.43

FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHAL HFAA

Facility

$1,310.38

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1,113.82
Max. Negotiated Rate	$1,271.07
Rate for Payer: Cash Price	$851.75
Rate for Payer: Health Management Network Commercial	$1,113.82
Rate for Payer: Kaiser Permanente Commercial	$1,179.34
Rate for Payer: MDX Hawaii PPO	$1,271.07

FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHAL HFAA

Facility

$1,310.38

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$655.19
Max. Negotiated Rate	$1,297.28
Rate for Payer: AlohaCare Medicaid	$655.19
Rate for Payer: AlohaCare Medicare	$1,179.34
Rate for Payer: Cash Price	$851.75
Rate for Payer: Devoted Health Medicare	$1,297.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,179.34
Rate for Payer: Hawaii Western Management Group Commercial	$1,244.86
Rate for Payer: Health Management Network Commercial	$1,113.82
Rate for Payer: Humana Medicare	$1,179.34
Rate for Payer: Kaiser Permanente Commercial	$1,179.34
Rate for Payer: Kaiser Permanente Medicaid	$668.29
Rate for Payer: Kaiser Permanente Medicare	$1,179.34
Rate for Payer: MDX Hawaii PPO	$1,271.07
Rate for Payer: Ohana Health Plan Medicaid	$1,179.34
Rate for Payer: Ohana Health Plan Medicare	$1,179.34
Rate for Payer: UnitedHealthcare Medicare	$1,179.34
Rate for Payer: University Health Alliance Commercial	$955.14

FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHAL HFAA

Facility

$2,025.42

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1,012.71
Max. Negotiated Rate	$2,005.17
Rate for Payer: AlohaCare Medicaid	$1,012.71
Rate for Payer: AlohaCare Medicare	$1,822.88
Rate for Payer: Cash Price	$1,316.52
Rate for Payer: Devoted Health Medicare	$2,005.17
Rate for Payer: Hawaii Medical Service Association Medicare	$1,822.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.15
Rate for Payer: Health Management Network Commercial	$1,721.61
Rate for Payer: Humana Medicare	$1,822.88
Rate for Payer: Kaiser Permanente Commercial	$1,822.88
Rate for Payer: Kaiser Permanente Medicaid	$1,032.96
Rate for Payer: Kaiser Permanente Medicare	$1,822.88
Rate for Payer: MDX Hawaii PPO	$1,964.66
Rate for Payer: Ohana Health Plan Medicaid	$1,822.88
Rate for Payer: Ohana Health Plan Medicare	$1,822.88
Rate for Payer: UnitedHealthcare Medicare	$1,822.88
Rate for Payer: University Health Alliance Commercial	$1,476.33

FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHAL HFAA

Facility

$2,025.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1,721.61
Max. Negotiated Rate	$1,964.66
Rate for Payer: Cash Price	$1,316.52
Rate for Payer: Health Management Network Commercial	$1,721.61
Rate for Payer: Kaiser Permanente Commercial	$1,822.88
Rate for Payer: MDX Hawaii PPO	$1,964.66

Know your out-of-pocket cost for care.

All Charges