Kona Community Hospital

All Charges

Charge

Type

Setting

Price

FLUCONAZOLE 100 MG PO TABLET

Facility

$51.94

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$44.15
Max. Negotiated Rate	$50.38
Rate for Payer: Cash Price	$33.76
Rate for Payer: Cash Price	$76.28
Rate for Payer: Cash Price	$5.08
Rate for Payer: Health Management Network Commercial	$44.15
Rate for Payer: Health Management Network Commercial	$99.76
Rate for Payer: Health Management Network Commercial	$6.65
Rate for Payer: MDX Hawaii PPO	$113.84
Rate for Payer: MDX Hawaii PPO	$7.59
Rate for Payer: MDX Hawaii PPO	$50.38

FLUCONAZOLE 150 MG PO TABLET

Facility

$76.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$38.77
Max. Negotiated Rate	$73.73
Rate for Payer: Cash Price	$49.41
Rate for Payer: Hawaii Western Management Group Commercial	$72.21
Rate for Payer: Health Management Network Commercial	$64.61
Rate for Payer: Kaiser Permanente Commercial	$47.89
Rate for Payer: Kaiser Permanente Medicaid	$38.77
Rate for Payer: MDX Hawaii PPO	$73.73
Rate for Payer: UnitedHealthcare Medicaid	$45.61
Rate for Payer: University Health Alliance Commercial	$55.40

FLUCONAZOLE 150 MG PO TABLET

Facility

$76.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$64.61
Max. Negotiated Rate	$73.73
Rate for Payer: Cash Price	$49.41
Rate for Payer: Health Management Network Commercial	$64.61
Rate for Payer: MDX Hawaii PPO	$73.73

FLUCONAZOLE 200 MG PO TABLET

Facility

$200.16

Service Code	NDC 68084073511
Hospital Revenue Code	250
Min. Negotiated Rate	$170.14
Max. Negotiated Rate	$194.16
Rate for Payer: Cash Price	$130.10
Rate for Payer: Health Management Network Commercial	$170.14
Rate for Payer: MDX Hawaii PPO	$194.16

FLUCONAZOLE 200 MG PO TABLET

Facility

$200.16

Service Code	NDC 68084073511
Hospital Revenue Code	250
Min. Negotiated Rate	$102.08
Max. Negotiated Rate	$194.16
Rate for Payer: Cash Price	$130.10
Rate for Payer: Hawaii Western Management Group Commercial	$190.15
Rate for Payer: Health Management Network Commercial	$170.14
Rate for Payer: Kaiser Permanente Commercial	$126.10
Rate for Payer: Kaiser Permanente Medicaid	$102.08
Rate for Payer: MDX Hawaii PPO	$194.16
Rate for Payer: UnitedHealthcare Medicaid	$120.10
Rate for Payer: University Health Alliance Commercial	$145.90

FLUCONAZOLE 200 MG PO TABLET

Facility

$200.16

Service Code	NDC 68084073501
Hospital Revenue Code	250
Min. Negotiated Rate	$102.08
Max. Negotiated Rate	$194.16
Rate for Payer: Cash Price	$130.10
Rate for Payer: Hawaii Western Management Group Commercial	$190.15
Rate for Payer: Health Management Network Commercial	$170.14
Rate for Payer: Kaiser Permanente Commercial	$126.10
Rate for Payer: Kaiser Permanente Medicaid	$102.08
Rate for Payer: MDX Hawaii PPO	$194.16
Rate for Payer: UnitedHealthcare Medicaid	$120.10
Rate for Payer: University Health Alliance Commercial	$145.90

FLUCONAZOLE 200 MG PO TABLET

Facility

$200.16

Service Code	NDC 68084073501
Hospital Revenue Code	250
Min. Negotiated Rate	$170.14
Max. Negotiated Rate	$194.16
Rate for Payer: Cash Price	$130.10
Rate for Payer: Health Management Network Commercial	$170.14
Rate for Payer: MDX Hawaii PPO	$194.16

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: 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	$51.54
Rate for Payer: Cash Price	$34.53
Rate for Payer: Cash Price	$34.53
Rate for Payer: Hawaii Medical Service Association ABD	$2.26
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: Kaiser Permanente Commercial	$33.47
Rate for Payer: Kaiser Permanente Medicaid	$27.10
Rate for Payer: MDX Hawaii PPO	$51.54
Rate for Payer: UnitedHealthcare Medicaid	$31.88
Rate for Payer: University Health Alliance Commercial	$38.73

FLUCONAZOLE IN NORMAL SALINE 400 MG/200 ML IV IVPB (PREMIX)

Facility

$75.96

Service Code	HCPCS J1450
Hospital Revenue Code	250
Min. Negotiated Rate	$64.57
Max. Negotiated Rate	$73.68
Rate for Payer: Cash Price	$49.37
Rate for Payer: Health Management Network Commercial	$64.57
Rate for Payer: MDX Hawaii PPO	$73.68

FLUCONAZOLE IN NORMAL SALINE 400 MG/200 ML IV IVPB (PREMIX)

Facility

$75.96

Service Code	HCPCS J1450
Hospital Revenue Code	636
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$73.68
Rate for Payer: Cash Price	$49.37
Rate for Payer: Cash Price	$49.37
Rate for Payer: Hawaii Medical Service Association ABD	$2.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.26
Rate for Payer: Hawaii Western Management Group Commercial	$72.16
Rate for Payer: Health Management Network Commercial	$64.57
Rate for Payer: Kaiser Permanente Commercial	$47.85
Rate for Payer: Kaiser Permanente Medicaid	$38.74
Rate for Payer: MDX Hawaii PPO	$73.68
Rate for Payer: UnitedHealthcare Medicaid	$45.58
Rate for Payer: University Health Alliance Commercial	$55.37

FLUCYTOSINE 500 MG PO CAP

Facility

$569.68

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$290.54
Max. Negotiated Rate	$552.59
Rate for Payer: Cash Price	$370.29
Rate for Payer: Hawaii Western Management Group Commercial	$541.20
Rate for Payer: Health Management Network Commercial	$484.23
Rate for Payer: Kaiser Permanente Commercial	$358.90
Rate for Payer: Kaiser Permanente Medicaid	$290.54
Rate for Payer: MDX Hawaii PPO	$552.59
Rate for Payer: UnitedHealthcare Medicaid	$341.81
Rate for Payer: University Health Alliance Commercial	$415.24

FLUCYTOSINE 500 MG PO CAP

Facility

$569.68

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$484.23
Max. Negotiated Rate	$552.59
Rate for Payer: Cash Price	$370.29
Rate for Payer: Health Management Network Commercial	$484.23
Rate for Payer: MDX Hawaii PPO	$552.59

FLUDROCORTISONE 0.1 MG PO TABLET

Facility

$8.83

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$8.57
Rate for Payer: Cash Price	$5.74
Rate for Payer: Hawaii Western Management Group Commercial	$8.39
Rate for Payer: Health Management Network Commercial	$7.51
Rate for Payer: Kaiser Permanente Commercial	$5.56
Rate for Payer: Kaiser Permanente Medicaid	$4.50
Rate for Payer: MDX Hawaii PPO	$8.57
Rate for Payer: UnitedHealthcare Medicaid	$5.30
Rate for Payer: University Health Alliance Commercial	$6.44

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: MDX Hawaii PPO	$8.57

Fluent Pro Fluid Management Sys FLT-212S [3643308]

Facility

$2,205.87

Hospital Charge Code	3643308
Hospital Revenue Code	272
Min. Negotiated Rate	$1,874.99
Max. Negotiated Rate	$2,139.69
Rate for Payer: Cash Price	$1,433.82
Rate for Payer: Health Management Network Commercial	$1,874.99
Rate for Payer: MDX Hawaii PPO	$2,139.69

Fluent Pro Fluid Management Sys FLT-212S [3643308]

Facility

$2,205.87

Hospital Charge Code	3643308
Hospital Revenue Code	272
Min. Negotiated Rate	$1,124.99
Max. Negotiated Rate	$2,139.69
Rate for Payer: Cash Price	$1,433.82
Rate for Payer: Hawaii Western Management Group Commercial	$2,095.58
Rate for Payer: Health Management Network Commercial	$1,874.99
Rate for Payer: Kaiser Permanente Commercial	$1,389.70
Rate for Payer: Kaiser Permanente Medicaid	$1,124.99
Rate for Payer: MDX Hawaii PPO	$2,139.69
Rate for Payer: University Health Alliance Commercial	$1,607.86

FLUMAZENIL 0.1 MG/ML IV SOLN 5 ML VIAL

Facility

$43.87

Service Code	NDC 36000014801
Hospital Revenue Code	250
Min. Negotiated Rate	$22.37
Max. Negotiated Rate	$42.55
Rate for Payer: Cash Price	$28.52
Rate for Payer: Hawaii Western Management Group Commercial	$41.68
Rate for Payer: Health Management Network Commercial	$37.29
Rate for Payer: Kaiser Permanente Commercial	$27.64
Rate for Payer: Kaiser Permanente Medicaid	$22.37
Rate for Payer: MDX Hawaii PPO	$42.55
Rate for Payer: UnitedHealthcare Medicaid	$26.32
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: 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: MDX Hawaii PPO	$42.55

FLUMAZENIL 0.1 MG/ML IV SOLN 5 ML VIAL

Facility

$43.87

Service Code	NDC 36000014810
Hospital Revenue Code	250
Min. Negotiated Rate	$22.37
Max. Negotiated Rate	$42.55
Rate for Payer: Cash Price	$28.52
Rate for Payer: Hawaii Western Management Group Commercial	$41.68
Rate for Payer: Health Management Network Commercial	$37.29
Rate for Payer: Kaiser Permanente Commercial	$27.64
Rate for Payer: Kaiser Permanente Medicaid	$22.37
Rate for Payer: MDX Hawaii PPO	$42.55
Rate for Payer: UnitedHealthcare Medicaid	$26.32
Rate for Payer: University Health Alliance Commercial	$31.98

FLUOCINONIDE 0.05 % TOP CR

Facility

$206.60

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$105.37
Max. Negotiated Rate	$200.40
Rate for Payer: Cash Price	$134.29
Rate for Payer: Hawaii Western Management Group Commercial	$196.27
Rate for Payer: Health Management Network Commercial	$175.61
Rate for Payer: Kaiser Permanente Commercial	$130.16
Rate for Payer: Kaiser Permanente Medicaid	$105.37
Rate for Payer: MDX Hawaii PPO	$200.40
Rate for Payer: UnitedHealthcare Medicaid	$123.96
Rate for Payer: University Health Alliance Commercial	$150.59

FLUOCINONIDE 0.05 % TOP CR

Facility

$206.60

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$175.61
Max. Negotiated Rate	$200.40
Rate for Payer: Cash Price	$134.29
Rate for Payer: Health Management Network Commercial	$175.61
Rate for Payer: MDX Hawaii PPO	$200.40

FLUORESCEIN 1 MG OPHT STRIP

Facility

$1.46

Service Code	NDC 17238090011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$1.42
Rate for Payer: Cash Price	$0.95
Rate for Payer: Hawaii Western Management Group Commercial	$1.39
Rate for Payer: Health Management Network Commercial	$1.24
Rate for Payer: Kaiser Permanente Commercial	$0.92
Rate for Payer: Kaiser Permanente Medicaid	$0.74
Rate for Payer: MDX Hawaii PPO	$1.42
Rate for Payer: UnitedHealthcare Medicaid	$0.88
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	$0.74
Max. Negotiated Rate	$1.42
Rate for Payer: Cash Price	$0.95
Rate for Payer: Hawaii Western Management Group Commercial	$1.39
Rate for Payer: Health Management Network Commercial	$1.24
Rate for Payer: Kaiser Permanente Commercial	$0.92
Rate for Payer: Kaiser Permanente Medicaid	$0.74
Rate for Payer: MDX Hawaii PPO	$1.42
Rate for Payer: UnitedHealthcare Medicaid	$0.88
Rate for Payer: University Health Alliance Commercial	$1.06

Know your out-of-pocket cost for care.

All Charges