Kau Hospital

All Charges

Charge

Type

Setting

Price

VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION [41673]

Facility

$160.00

Service Code	HCPCS J9390
Hospital Revenue Code	250
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$162.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Health Management Network Commercial	$229.50
Rate for Payer: Kaiser Permanente Commercial	$144.00
Rate for Payer: Kaiser Permanente Commercial	$243.00
Rate for Payer: MDX Hawaii PPO	$261.90
Rate for Payer: MDX Hawaii PPO	$155.20

VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION [41673]

Facility

$160.00

Service Code	HCPCS J9390
Hospital Revenue Code	636
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$155.20
Rate for Payer: AlohaCare Medicaid	$80.00
Rate for Payer: AlohaCare Medicaid	$135.00
Rate for Payer: AlohaCare Medicare	$83.70
Rate for Payer: AlohaCare Medicare	$49.60
Rate for Payer: Cash Price	$162.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$162.00
Rate for Payer: Devoted Health Medicare	$54.40
Rate for Payer: Devoted Health Medicare	$91.80
Rate for Payer: Hawaii Medical Service Association ABD	$1.96
Rate for Payer: Hawaii Medical Service Association ABD	$1.96
Rate for Payer: Hawaii Medical Service Association Medicare	$83.70
Rate for Payer: Hawaii Medical Service Association Medicare	$49.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.96
Rate for Payer: Hawaii Western Management Group Commercial	$152.00
Rate for Payer: Hawaii Western Management Group Commercial	$256.50
Rate for Payer: Health Management Network Commercial	$229.50
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Humana Medicare	$49.60
Rate for Payer: Humana Medicare	$83.70
Rate for Payer: Kaiser Permanente Commercial	$144.00
Rate for Payer: Kaiser Permanente Commercial	$243.00
Rate for Payer: Kaiser Permanente Medicaid	$137.70
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: Kaiser Permanente Medicare	$49.60
Rate for Payer: Kaiser Permanente Medicare	$83.70
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: MDX Hawaii PPO	$261.90
Rate for Payer: Ohana Health Plan Medicaid	$83.70
Rate for Payer: Ohana Health Plan Medicaid	$49.60
Rate for Payer: Ohana Health Plan Medicare	$49.60
Rate for Payer: Ohana Health Plan Medicare	$83.70
Rate for Payer: UnitedHealthcare Medicaid	$162.00
Rate for Payer: UnitedHealthcare Medicaid	$96.00
Rate for Payer: UnitedHealthcare Medicare	$49.60
Rate for Payer: UnitedHealthcare Medicare	$83.70
Rate for Payer: University Health Alliance Commercial	$116.62
Rate for Payer: University Health Alliance Commercial	$196.80

VIRAL ILLNESS WITH MCC

Facility

$24,341.95

Service Code	MSDRG 865
Min. Negotiated Rate	$24,341.95
Max. Negotiated Rate	$24,341.95
Rate for Payer: Hawaii Medical Service Association Commercial	$24,341.95

VIRAL ILLNESS WITHOUT MCC

Facility

$22,825.03

Service Code	MSDRG 866
Min. Negotiated Rate	$22,825.03
Max. Negotiated Rate	$22,825.03
Rate for Payer: Hawaii Medical Service Association Commercial	$22,825.03

VIRAL MENINGITIS WITH CC/MCC

Facility

$14,102.69

Service Code	MSDRG 075
Min. Negotiated Rate	$14,102.69
Max. Negotiated Rate	$14,102.69
Rate for Payer: Hawaii Medical Service Association Commercial	$14,102.69

VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$14,102.69

Service Code	MSDRG 076
Min. Negotiated Rate	$14,102.69
Max. Negotiated Rate	$14,102.69
Rate for Payer: Hawaii Medical Service Association Commercial	$14,102.69

VISIONIST X4

Facility

$11,512.00

Service Code	HCPCS C2621
Hospital Revenue Code	275
Min. Negotiated Rate	$6,446.72
Max. Negotiated Rate	$11,166.64
Rate for Payer: Cash Price	$6,907.20
Rate for Payer: Hawaii Western Management Group Commercial	$8,058.40
Rate for Payer: Health Management Network Commercial	$9,785.20
Rate for Payer: Kaiser Permanente Commercial	$10,360.80
Rate for Payer: MDX Hawaii PPO	$11,166.64
Rate for Payer: University Health Alliance Commercial	$6,446.72

VISIONIST X4

Facility

$11,512.00

Service Code	HCPCS C2621
Hospital Revenue Code	275
Min. Negotiated Rate	$3,568.72
Max. Negotiated Rate	$11,166.64
Rate for Payer: AlohaCare Medicaid	$5,756.00
Rate for Payer: AlohaCare Medicare	$3,568.72
Rate for Payer: Cash Price	$6,907.20
Rate for Payer: Devoted Health Medicare	$3,914.08
Rate for Payer: Hawaii Medical Service Association Medicare	$3,568.72
Rate for Payer: Hawaii Western Management Group Commercial	$8,058.40
Rate for Payer: Health Management Network Commercial	$9,785.20
Rate for Payer: Humana Medicare	$3,568.72
Rate for Payer: Kaiser Permanente Commercial	$10,360.80
Rate for Payer: Kaiser Permanente Medicaid	$5,871.12
Rate for Payer: Kaiser Permanente Medicare	$3,568.72
Rate for Payer: MDX Hawaii PPO	$11,166.64
Rate for Payer: Ohana Health Plan Medicaid	$3,568.72
Rate for Payer: Ohana Health Plan Medicare	$3,568.72
Rate for Payer: UnitedHealthcare Medicare	$3,568.72
Rate for Payer: University Health Alliance Commercial	$6,446.72

VISTA COLLAR, ADULT 79-83370

Facility

$201.00

Service Code	HCPCS L0172
Hospital Revenue Code	274
Min. Negotiated Rate	$112.56
Max. Negotiated Rate	$194.97
Rate for Payer: Cash Price	$120.60
Rate for Payer: Hawaii Western Management Group Commercial	$140.70
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: MDX Hawaii PPO	$194.97
Rate for Payer: University Health Alliance Commercial	$112.56

VISTA COLLAR, ADULT 79-83370

Facility

$201.00

Service Code	HCPCS L0172
Hospital Revenue Code	274
Min. Negotiated Rate	$62.31
Max. Negotiated Rate	$194.97
Rate for Payer: AlohaCare Medicaid	$100.50
Rate for Payer: AlohaCare Medicare	$62.31
Rate for Payer: Cash Price	$120.60
Rate for Payer: Cash Price	$120.60
Rate for Payer: Devoted Health Medicare	$68.34
Rate for Payer: Hawaii Medical Service Association Medicare	$62.31
Rate for Payer: Hawaii Western Management Group Commercial	$140.70
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Humana Medicare	$62.31
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: Kaiser Permanente Medicaid	$102.51
Rate for Payer: Kaiser Permanente Medicare	$62.31
Rate for Payer: MDX Hawaii PPO	$194.97
Rate for Payer: Ohana Health Plan Medicaid	$62.31
Rate for Payer: Ohana Health Plan Medicare	$62.31
Rate for Payer: UnitedHealthcare Medicaid	$78.38
Rate for Payer: UnitedHealthcare Medicare	$62.31
Rate for Payer: University Health Alliance Commercial	$112.56

VITAMIN A PALMITATE 3,000 MCG (10,000 UNIT) CAPSULE [201407]

Facility

$1.00

Service Code	NDC 40725000000
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

VITAMIN A PALMITATE 3,000 MCG (10,000 UNIT) CAPSULE [201407]

Facility

$1.00

Service Code	NDC 40725000000
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

VITAMIN B COMPLEX CAPSULE [804]

Facility

$1.00

Service Code	NDC 37801000000
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

VITAMIN B COMPLEX CAPSULE [804]

Facility

$1.00

Service Code	NDC 37801000000
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

VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET [5495]

Facility

$1.00

Service Code	NDC 16001000000
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

VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET [5495]

Facility

$1.00

Service Code	NDC 16001000000
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

VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE [180774]

Facility

$1.00

Service Code	NDC 95125000000
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

VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE [180774]

Facility

$1.00

Service Code	NDC 40754000000
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

VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE [180774]

Facility

$1.00

Service Code	NDC 95125000000
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

VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE [180774]

Facility

$1.00

Service Code	NDC 40754000000
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

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT [8723]

Facility

$17.00

Service Code	NDC 65197040101
Hospital Revenue Code	250
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: MDX Hawaii PPO	$16.49

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT [8723]

Facility

$17.00

Service Code	NDC 65197040101
Hospital Revenue Code	637
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$16.49
Rate for Payer: AlohaCare Medicaid	$8.50
Rate for Payer: AlohaCare Medicare	$5.27
Rate for Payer: Cash Price	$10.20
Rate for Payer: Devoted Health Medicare	$5.78
Rate for Payer: Hawaii Medical Service Association Medicare	$5.27
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Humana Medicare	$5.27
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: Kaiser Permanente Medicare	$5.27
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: Ohana Health Plan Medicaid	$5.27
Rate for Payer: Ohana Health Plan Medicare	$5.27
Rate for Payer: UnitedHealthcare Medicare	$5.27
Rate for Payer: University Health Alliance Commercial	$12.39

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT [8723]

Facility

$16.00

Service Code	NDC 71399012204
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT [8723]

Facility

$16.00

Service Code	NDC 71399012204
Hospital Revenue Code	637
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$15.52
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$4.96
Rate for Payer: Cash Price	$9.60
Rate for Payer: Devoted Health Medicare	$5.44
Rate for Payer: Hawaii Medical Service Association Medicare	$4.96
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Humana Medicare	$4.96
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$4.96
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$4.96
Rate for Payer: Ohana Health Plan Medicare	$4.96
Rate for Payer: UnitedHealthcare Medicare	$4.96
Rate for Payer: University Health Alliance Commercial	$11.66

VITOSS 2.5CC 2102-2202

Facility

$2,444.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$757.64
Max. Negotiated Rate	$2,370.68
Rate for Payer: AlohaCare Medicaid	$1,222.00
Rate for Payer: AlohaCare Medicare	$757.64
Rate for Payer: Cash Price	$1,466.40
Rate for Payer: Devoted Health Medicare	$830.96
Rate for Payer: Hawaii Medical Service Association Medicare	$757.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,710.80
Rate for Payer: Health Management Network Commercial	$2,077.40
Rate for Payer: Humana Medicare	$757.64
Rate for Payer: Kaiser Permanente Commercial	$2,199.60
Rate for Payer: Kaiser Permanente Medicaid	$1,246.44
Rate for Payer: Kaiser Permanente Medicare	$757.64
Rate for Payer: MDX Hawaii PPO	$2,370.68
Rate for Payer: Ohana Health Plan Medicaid	$757.64
Rate for Payer: Ohana Health Plan Medicare	$757.64
Rate for Payer: UnitedHealthcare Medicare	$757.64
Rate for Payer: University Health Alliance Commercial	$1,368.64

Know your out-of-pocket cost for care.

All Charges