Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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: MDX Hawaii PPO	$1.25

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 17238090011
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: MDX Hawaii PPO	$1.42

FLUORESCEIN 1 MG OPHT STRIP

Facility

$1.29

Service Code	NDC 83851010030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$1.25
Rate for Payer: Cash Price	$0.84
Rate for Payer: Hawaii Western Management Group Commercial	$1.23
Rate for Payer: Health Management Network Commercial	$1.10
Rate for Payer: Kaiser Permanente Commercial	$0.81
Rate for Payer: Kaiser Permanente Medicaid	$0.66
Rate for Payer: MDX Hawaii PPO	$1.25
Rate for Payer: UnitedHealthcare Medicaid	$0.77
Rate for Payer: University Health Alliance Commercial	$0.94

FLUORESCEIN 1 MG OPHT STRIP

Facility

$1.29

Service Code	NDC 83851010001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$1.25
Rate for Payer: Cash Price	$0.84
Rate for Payer: Hawaii Western Management Group Commercial	$1.23
Rate for Payer: Health Management Network Commercial	$1.10
Rate for Payer: Kaiser Permanente Commercial	$0.81
Rate for Payer: Kaiser Permanente Medicaid	$0.66
Rate for Payer: MDX Hawaii PPO	$1.25
Rate for Payer: UnitedHealthcare Medicaid	$0.77
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	$0.74
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 500 MG/5 ML (10 %) IV SOLN

Facility

$225.00

Service Code	HCPCS A9612
Hospital Revenue Code	250
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: MDX Hawaii PPO	$218.25

FLUORESCEIN 500 MG/5 ML (10 %) IV SOLN

Facility

$225.00

Service Code	HCPCS A9612
Hospital Revenue Code	250
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$141.75
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: UnitedHealthcare Medicaid	$135.00
Rate for Payer: University Health Alliance Commercial	$164.00

FLUORODEOXYGLUCOSE F-18 FDG DX UP TO 45 MCI

Professional

Both

$750.00

Service Code	HCPCS A9552
Min. Negotiated Rate	$390.00
Max. Negotiated Rate	$637.50
Rate for Payer: Cash Price	$487.50
Rate for Payer: Cash Price	$487.50
Rate for Payer: Hawaii Western Management Group Commercial	$390.00
Rate for Payer: Health Management Network Commercial	$637.50

FLUOROURACIL 1 GRAM/20 ML IV SOLN

Facility

$136.82

Service Code	HCPCS J9190
Hospital Revenue Code	250
Min. Negotiated Rate	$116.30
Max. Negotiated Rate	$132.72
Rate for Payer: Cash Price	$88.93
Rate for Payer: Health Management Network Commercial	$116.30
Rate for Payer: MDX Hawaii PPO	$132.72

FLUOROURACIL 1 GRAM/20 ML IV SOLN

Facility

$136.82

Service Code	HCPCS J9190
Hospital Revenue Code	636
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$132.72
Rate for Payer: Cash Price	$88.93
Rate for Payer: Cash Price	$88.93
Rate for Payer: Hawaii Medical Service Association ABD	$1.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.72
Rate for Payer: Hawaii Western Management Group Commercial	$129.98
Rate for Payer: Health Management Network Commercial	$116.30
Rate for Payer: Kaiser Permanente Commercial	$86.20
Rate for Payer: Kaiser Permanente Medicaid	$69.78
Rate for Payer: MDX Hawaii PPO	$132.72
Rate for Payer: UnitedHealthcare Medicaid	$82.09
Rate for Payer: University Health Alliance Commercial	$99.73

FLUOROURACIL 500 MG/10 ML IV SOLN

Facility

$18.88

Service Code	HCPCS J9190
Hospital Revenue Code	636
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$18.31
Rate for Payer: Cash Price	$12.27
Rate for Payer: Cash Price	$12.27
Rate for Payer: Cash Price	$54.60
Rate for Payer: Cash Price	$54.60
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 Non-ABD	$1.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.72
Rate for Payer: Hawaii Western Management Group Commercial	$17.94
Rate for Payer: Hawaii Western Management Group Commercial	$79.80
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Health Management Network Commercial	$16.05
Rate for Payer: Kaiser Permanente Commercial	$52.92
Rate for Payer: Kaiser Permanente Commercial	$11.89
Rate for Payer: Kaiser Permanente Medicaid	$9.63
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: MDX Hawaii PPO	$18.31
Rate for Payer: UnitedHealthcare Medicaid	$11.33
Rate for Payer: UnitedHealthcare Medicaid	$50.40
Rate for Payer: University Health Alliance Commercial	$61.23
Rate for Payer: University Health Alliance Commercial	$13.76

FLUOROURACIL 500 MG/10 ML IV SOLN

Facility

$84.00

Service Code	HCPCS J9190
Hospital Revenue Code	250
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$54.60
Rate for Payer: Cash Price	$12.27
Rate for Payer: Health Management Network Commercial	$16.05
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: MDX Hawaii PPO	$18.31

FLUOROURACIL 5 G/100 ML IV SOLN

Facility

$139.31

Service Code	HCPCS J9190
Hospital Revenue Code	636
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$135.13
Rate for Payer: Cash Price	$90.55
Rate for Payer: Cash Price	$90.55
Rate for Payer: Hawaii Medical Service Association ABD	$1.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.72
Rate for Payer: Hawaii Western Management Group Commercial	$132.34
Rate for Payer: Health Management Network Commercial	$118.41
Rate for Payer: Kaiser Permanente Commercial	$87.77
Rate for Payer: Kaiser Permanente Medicaid	$71.05
Rate for Payer: MDX Hawaii PPO	$135.13
Rate for Payer: UnitedHealthcare Medicaid	$83.59
Rate for Payer: University Health Alliance Commercial	$101.54

FLUOROURACIL 5 G/100 ML IV SOLN

Facility

$139.31

Service Code	HCPCS J9190
Hospital Revenue Code	250
Min. Negotiated Rate	$118.41
Max. Negotiated Rate	$135.13
Rate for Payer: Cash Price	$90.55
Rate for Payer: Health Management Network Commercial	$118.41
Rate for Payer: MDX Hawaii PPO	$135.13

FLUOXETINE 10 MG PO CAP

Facility

$14.35

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.32
Max. Negotiated Rate	$13.92
Rate for Payer: Cash Price	$9.33
Rate for Payer: Hawaii Western Management Group Commercial	$13.63
Rate for Payer: Health Management Network Commercial	$12.20
Rate for Payer: Kaiser Permanente Commercial	$9.04
Rate for Payer: Kaiser Permanente Medicaid	$7.32
Rate for Payer: MDX Hawaii PPO	$13.92
Rate for Payer: UnitedHealthcare Medicaid	$8.61
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: MDX Hawaii PPO	$13.92

FLUOXETINE 20 MG PO CAP

Facility

$1.20

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

FLUOXETINE 20 MG PO CAP

Facility

$14.73

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$14.29
Rate for Payer: Cash Price	$9.57
Rate for Payer: Cash Price	$0.78
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Hawaii Western Management Group Commercial	$13.99
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$12.52
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Commercial	$9.28
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicaid	$7.51
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$14.29
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: UnitedHealthcare Medicaid	$8.84
Rate for Payer: University Health Alliance Commercial	$10.74
Rate for Payer: University Health Alliance Commercial	$0.87

FLUPHENAZINE HCL 5 MG PO TABLET

Facility

$54.10

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$27.59
Max. Negotiated Rate	$52.48
Rate for Payer: Cash Price	$35.16
Rate for Payer: Hawaii Western Management Group Commercial	$51.40
Rate for Payer: Health Management Network Commercial	$45.98
Rate for Payer: Kaiser Permanente Commercial	$34.08
Rate for Payer: Kaiser Permanente Medicaid	$27.59
Rate for Payer: MDX Hawaii PPO	$52.48
Rate for Payer: UnitedHealthcare Medicaid	$32.46
Rate for Payer: University Health Alliance Commercial	$39.43

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: MDX Hawaii PPO	$52.48

FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHAL HFAA

Facility

$1,310.38

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$668.29
Max. Negotiated Rate	$1,271.07
Rate for Payer: Cash Price	$851.75
Rate for Payer: Hawaii Western Management Group Commercial	$1,244.86
Rate for Payer: Health Management Network Commercial	$1,113.82
Rate for Payer: Kaiser Permanente Commercial	$825.54
Rate for Payer: Kaiser Permanente Medicaid	$668.29
Rate for Payer: MDX Hawaii PPO	$1,271.07
Rate for Payer: UnitedHealthcare Medicaid	$786.23
Rate for Payer: University Health Alliance Commercial	$955.14

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: MDX Hawaii PPO	$1,271.07

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: MDX Hawaii PPO	$1,964.66

FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHAL HFAA

Facility

$2,025.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1,032.96
Max. Negotiated Rate	$1,964.66
Rate for Payer: Cash Price	$1,316.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.15
Rate for Payer: Health Management Network Commercial	$1,721.61
Rate for Payer: Kaiser Permanente Commercial	$1,276.01
Rate for Payer: Kaiser Permanente Medicaid	$1,032.96
Rate for Payer: MDX Hawaii PPO	$1,964.66
Rate for Payer: UnitedHealthcare Medicaid	$1,215.25
Rate for Payer: University Health Alliance Commercial	$1,476.33

Know your out-of-pocket cost for care.

All Charges