Kau Hospital

All Charges

Charge

Type

Setting

Price

VITOSS 2.5CC 2102-2202

Facility

$2,444.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,368.64
Max. Negotiated Rate	$2,370.68
Rate for Payer: Cash Price	$1,466.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,710.80
Rate for Payer: Health Management Network Commercial	$2,077.40
Rate for Payer: Kaiser Permanente Commercial	$2,199.60
Rate for Payer: MDX Hawaii PPO	$2,370.68
Rate for Payer: University Health Alliance Commercial	$1,368.64

VITOSS BONE GRAFT 2102-2205

Facility

$7,048.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,946.88
Max. Negotiated Rate	$6,836.56
Rate for Payer: Cash Price	$4,228.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,933.60
Rate for Payer: Health Management Network Commercial	$5,990.80
Rate for Payer: Kaiser Permanente Commercial	$6,343.20
Rate for Payer: MDX Hawaii PPO	$6,836.56
Rate for Payer: University Health Alliance Commercial	$3,946.88

VITOSS BONE GRAFT 2102-2205

Facility

$7,048.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,184.88
Max. Negotiated Rate	$6,836.56
Rate for Payer: AlohaCare Medicaid	$3,524.00
Rate for Payer: AlohaCare Medicare	$2,184.88
Rate for Payer: Cash Price	$4,228.80
Rate for Payer: Devoted Health Medicare	$2,396.32
Rate for Payer: Hawaii Medical Service Association Medicare	$2,184.88
Rate for Payer: Hawaii Western Management Group Commercial	$4,933.60
Rate for Payer: Health Management Network Commercial	$5,990.80
Rate for Payer: Humana Medicare	$2,184.88
Rate for Payer: Kaiser Permanente Commercial	$6,343.20
Rate for Payer: Kaiser Permanente Medicaid	$3,594.48
Rate for Payer: Kaiser Permanente Medicare	$2,184.88
Rate for Payer: MDX Hawaii PPO	$6,836.56
Rate for Payer: Ohana Health Plan Medicaid	$2,184.88
Rate for Payer: Ohana Health Plan Medicare	$2,184.88
Rate for Payer: UnitedHealthcare Medicare	$2,184.88
Rate for Payer: University Health Alliance Commercial	$3,946.88

VIVACIT-E 60X36MM 8851-014-36

Facility

$3,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,128.00
Max. Negotiated Rate	$3,686.00
Rate for Payer: Cash Price	$2,280.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,660.00
Rate for Payer: Health Management Network Commercial	$3,230.00
Rate for Payer: Kaiser Permanente Commercial	$3,420.00
Rate for Payer: MDX Hawaii PPO	$3,686.00
Rate for Payer: University Health Alliance Commercial	$2,128.00

VIVACIT-E 60X36MM 8851-014-36

Facility

$3,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,178.00
Max. Negotiated Rate	$3,686.00
Rate for Payer: AlohaCare Medicaid	$1,900.00
Rate for Payer: AlohaCare Medicare	$1,178.00
Rate for Payer: Cash Price	$2,280.00
Rate for Payer: Devoted Health Medicare	$1,292.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,178.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,660.00
Rate for Payer: Health Management Network Commercial	$3,230.00
Rate for Payer: Humana Medicare	$1,178.00
Rate for Payer: Kaiser Permanente Commercial	$3,420.00
Rate for Payer: Kaiser Permanente Medicaid	$1,938.00
Rate for Payer: Kaiser Permanente Medicare	$1,178.00
Rate for Payer: MDX Hawaii PPO	$3,686.00
Rate for Payer: Ohana Health Plan Medicaid	$1,178.00
Rate for Payer: Ohana Health Plan Medicare	$1,178.00
Rate for Payer: UnitedHealthcare Medicare	$1,178.00
Rate for Payer: University Health Alliance Commercial	$2,128.00

VLOC 3-0 CV-23 6" VLOCM0804

Facility

$124.00

Hospital Revenue Code	272
Min. Negotiated Rate	$105.40
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$74.40
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Kaiser Permanente Commercial	$111.60
Rate for Payer: MDX Hawaii PPO	$120.28

VLOC 3-0 CV-23 6" VLOCM0804

Facility

$124.00

Hospital Revenue Code	272
Min. Negotiated Rate	$38.44
Max. Negotiated Rate	$120.28
Rate for Payer: AlohaCare Medicaid	$62.00
Rate for Payer: AlohaCare Medicare	$38.44
Rate for Payer: Cash Price	$74.40
Rate for Payer: Devoted Health Medicare	$42.16
Rate for Payer: Hawaii Medical Service Association Medicare	$38.44
Rate for Payer: Hawaii Western Management Group Commercial	$117.80
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Humana Medicare	$38.44
Rate for Payer: Kaiser Permanente Commercial	$111.60
Rate for Payer: Kaiser Permanente Medicaid	$63.24
Rate for Payer: Kaiser Permanente Medicare	$38.44
Rate for Payer: MDX Hawaii PPO	$120.28
Rate for Payer: Ohana Health Plan Medicaid	$38.44
Rate for Payer: Ohana Health Plan Medicare	$38.44
Rate for Payer: UnitedHealthcare Medicare	$38.44
Rate for Payer: University Health Alliance Commercial	$90.38

VOL PLATE RT/5H/5PEG VLBPR-5-5

Facility

$3,020.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$936.20
Max. Negotiated Rate	$2,929.40
Rate for Payer: AlohaCare Medicaid	$1,510.00
Rate for Payer: AlohaCare Medicare	$936.20
Rate for Payer: Cash Price	$1,812.00
Rate for Payer: Devoted Health Medicare	$1,026.80
Rate for Payer: Hawaii Medical Service Association Medicare	$936.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,114.00
Rate for Payer: Health Management Network Commercial	$2,567.00
Rate for Payer: Humana Medicare	$936.20
Rate for Payer: Kaiser Permanente Commercial	$2,718.00
Rate for Payer: Kaiser Permanente Medicaid	$1,540.20
Rate for Payer: Kaiser Permanente Medicare	$936.20
Rate for Payer: MDX Hawaii PPO	$2,929.40
Rate for Payer: Ohana Health Plan Medicaid	$936.20
Rate for Payer: Ohana Health Plan Medicare	$936.20
Rate for Payer: UnitedHealthcare Medicare	$936.20
Rate for Payer: University Health Alliance Commercial	$1,691.20

VOL PLATE RT/5H/5PEG VLBPR-5-5

Facility

$3,020.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,691.20
Max. Negotiated Rate	$2,929.40
Rate for Payer: Cash Price	$1,812.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,114.00
Rate for Payer: Health Management Network Commercial	$2,567.00
Rate for Payer: Kaiser Permanente Commercial	$2,718.00
Rate for Payer: MDX Hawaii PPO	$2,929.40
Rate for Payer: University Health Alliance Commercial	$1,691.20

VORICONAZOLE 200 MG/20ML IV (WET SOLR VIAL) [43033010]

Facility

$125.00

Service Code	HCPCS J3465
Hospital Revenue Code	636
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$121.25
Rate for Payer: AlohaCare Medicaid	$62.50
Rate for Payer: AlohaCare Medicaid	$72.50
Rate for Payer: AlohaCare Medicare	$44.95
Rate for Payer: AlohaCare Medicare	$38.75
Rate for Payer: Cash Price	$87.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cash Price	$87.00
Rate for Payer: Devoted Health Medicare	$42.50
Rate for Payer: Devoted Health Medicare	$49.30
Rate for Payer: Hawaii Medical Service Association ABD	$0.78
Rate for Payer: Hawaii Medical Service Association ABD	$0.78
Rate for Payer: Hawaii Medical Service Association Medicare	$44.95
Rate for Payer: Hawaii Medical Service Association Medicare	$38.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.78
Rate for Payer: Hawaii Western Management Group Commercial	$137.75
Rate for Payer: Hawaii Western Management Group Commercial	$118.75
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$44.95
Rate for Payer: Humana Medicare	$38.75
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: Kaiser Permanente Medicare	$44.95
Rate for Payer: Kaiser Permanente Medicare	$38.75
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$38.75
Rate for Payer: Ohana Health Plan Medicaid	$44.95
Rate for Payer: Ohana Health Plan Medicare	$38.75
Rate for Payer: Ohana Health Plan Medicare	$44.95
Rate for Payer: UnitedHealthcare Medicaid	$75.00
Rate for Payer: UnitedHealthcare Medicaid	$87.00
Rate for Payer: UnitedHealthcare Medicare	$44.95
Rate for Payer: UnitedHealthcare Medicare	$38.75
Rate for Payer: University Health Alliance Commercial	$91.11
Rate for Payer: University Health Alliance Commercial	$105.69

VORICONAZOLE 200 MG/20ML IV (WET SOLR VIAL) [43033010]

Facility

$125.00

Service Code	HCPCS J3465
Hospital Revenue Code	250
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cash Price	$87.00
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: MDX Hawaii PPO	$121.25

VORICONAZOLE 200 MG INTRAVENOUS SOLUTION [33010]

Facility

$145.00

Service Code	HCPCS J3465
Hospital Revenue Code	250
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$87.00
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: MDX Hawaii PPO	$140.65

VORICONAZOLE 200 MG INTRAVENOUS SOLUTION [33010]

Facility

$145.00

Service Code	HCPCS J3465
Hospital Revenue Code	636
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$72.50
Rate for Payer: AlohaCare Medicare	$44.95
Rate for Payer: Cash Price	$87.00
Rate for Payer: Cash Price	$87.00
Rate for Payer: Devoted Health Medicare	$49.30
Rate for Payer: Hawaii Medical Service Association ABD	$0.78
Rate for Payer: Hawaii Medical Service Association Medicare	$44.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.78
Rate for Payer: Hawaii Western Management Group Commercial	$137.75
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$44.95
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$44.95
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$44.95
Rate for Payer: Ohana Health Plan Medicare	$44.95
Rate for Payer: UnitedHealthcare Medicaid	$87.00
Rate for Payer: UnitedHealthcare Medicare	$44.95
Rate for Payer: University Health Alliance Commercial	$105.69

VORICONAZOLE 200 MG TABLET [33009]

Facility

$118.00

Service Code	NDC 60687027311
Hospital Revenue Code	637
Min. Negotiated Rate	$36.58
Max. Negotiated Rate	$114.46
Rate for Payer: AlohaCare Medicaid	$59.00
Rate for Payer: AlohaCare Medicare	$36.58
Rate for Payer: Cash Price	$70.80
Rate for Payer: Devoted Health Medicare	$40.12
Rate for Payer: Hawaii Medical Service Association Medicare	$36.58
Rate for Payer: Hawaii Western Management Group Commercial	$112.10
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Humana Medicare	$36.58
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: Kaiser Permanente Medicaid	$60.18
Rate for Payer: Kaiser Permanente Medicare	$36.58
Rate for Payer: MDX Hawaii PPO	$114.46
Rate for Payer: Ohana Health Plan Medicaid	$36.58
Rate for Payer: Ohana Health Plan Medicare	$36.58
Rate for Payer: UnitedHealthcare Medicare	$36.58
Rate for Payer: University Health Alliance Commercial	$86.01

VORICONAZOLE 200 MG TABLET [33009]

Facility

$60.00

Service Code	NDC 50268080312
Hospital Revenue Code	250
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: MDX Hawaii PPO	$58.20

VORICONAZOLE 200 MG TABLET [33009]

Facility

$60.00

Service Code	NDC 50268080312
Hospital Revenue Code	637
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$58.20
Rate for Payer: AlohaCare Medicaid	$30.00
Rate for Payer: AlohaCare Medicare	$18.60
Rate for Payer: Cash Price	$36.00
Rate for Payer: Devoted Health Medicare	$20.40
Rate for Payer: Hawaii Medical Service Association Medicare	$18.60
Rate for Payer: Hawaii Western Management Group Commercial	$57.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Humana Medicare	$18.60
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: Kaiser Permanente Medicare	$18.60
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: Ohana Health Plan Medicaid	$18.60
Rate for Payer: Ohana Health Plan Medicare	$18.60
Rate for Payer: UnitedHealthcare Medicare	$18.60
Rate for Payer: University Health Alliance Commercial	$43.73

VORICONAZOLE 200 MG TABLET [33009]

Facility

$60.00

Service Code	NDC 50268080311
Hospital Revenue Code	637
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$58.20
Rate for Payer: AlohaCare Medicaid	$30.00
Rate for Payer: AlohaCare Medicare	$18.60
Rate for Payer: Cash Price	$36.00
Rate for Payer: Devoted Health Medicare	$20.40
Rate for Payer: Hawaii Medical Service Association Medicare	$18.60
Rate for Payer: Hawaii Western Management Group Commercial	$57.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Humana Medicare	$18.60
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: Kaiser Permanente Medicare	$18.60
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: Ohana Health Plan Medicaid	$18.60
Rate for Payer: Ohana Health Plan Medicare	$18.60
Rate for Payer: UnitedHealthcare Medicare	$18.60
Rate for Payer: University Health Alliance Commercial	$43.73

VORICONAZOLE 200 MG TABLET [33009]

Facility

$67.00

Service Code	NDC 00904702404
Hospital Revenue Code	250
Min. Negotiated Rate	$56.95
Max. Negotiated Rate	$64.99
Rate for Payer: Cash Price	$40.20
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: Kaiser Permanente Commercial	$60.30
Rate for Payer: MDX Hawaii PPO	$64.99

VORICONAZOLE 200 MG TABLET [33009]

Facility

$60.00

Service Code	NDC 50268080311
Hospital Revenue Code	250
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: MDX Hawaii PPO	$58.20

VORICONAZOLE 200 MG TABLET [33009]

Facility

$118.00

Service Code	NDC 60687027311
Hospital Revenue Code	250
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$70.80
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: MDX Hawaii PPO	$114.46

VORICONAZOLE 200 MG TABLET [33009]

Facility

$160.00

Service Code	NDC 68462057330
Hospital Revenue Code	637
Min. Negotiated Rate	$49.60
Max. Negotiated Rate	$155.20
Rate for Payer: AlohaCare Medicaid	$80.00
Rate for Payer: AlohaCare Medicare	$49.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Devoted Health Medicare	$54.40
Rate for Payer: Hawaii Medical Service Association Medicare	$49.60
Rate for Payer: Hawaii Western Management Group Commercial	$152.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Humana Medicare	$49.60
Rate for Payer: Kaiser Permanente Commercial	$144.00
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: Kaiser Permanente Medicare	$49.60
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: Ohana Health Plan Medicaid	$49.60
Rate for Payer: Ohana Health Plan Medicare	$49.60
Rate for Payer: UnitedHealthcare Medicare	$49.60
Rate for Payer: University Health Alliance Commercial	$116.62

VORICONAZOLE 200 MG TABLET [33009]

Facility

$118.00

Service Code	NDC 60687027321
Hospital Revenue Code	637
Min. Negotiated Rate	$36.58
Max. Negotiated Rate	$114.46
Rate for Payer: AlohaCare Medicaid	$59.00
Rate for Payer: AlohaCare Medicare	$36.58
Rate for Payer: Cash Price	$70.80
Rate for Payer: Devoted Health Medicare	$40.12
Rate for Payer: Hawaii Medical Service Association Medicare	$36.58
Rate for Payer: Hawaii Western Management Group Commercial	$112.10
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Humana Medicare	$36.58
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: Kaiser Permanente Medicaid	$60.18
Rate for Payer: Kaiser Permanente Medicare	$36.58
Rate for Payer: MDX Hawaii PPO	$114.46
Rate for Payer: Ohana Health Plan Medicaid	$36.58
Rate for Payer: Ohana Health Plan Medicare	$36.58
Rate for Payer: UnitedHealthcare Medicare	$36.58
Rate for Payer: University Health Alliance Commercial	$86.01

VORICONAZOLE 200 MG TABLET [33009]

Facility

$67.00

Service Code	NDC 00904702404
Hospital Revenue Code	637
Min. Negotiated Rate	$20.77
Max. Negotiated Rate	$64.99
Rate for Payer: AlohaCare Medicaid	$33.50
Rate for Payer: AlohaCare Medicare	$20.77
Rate for Payer: Cash Price	$40.20
Rate for Payer: Devoted Health Medicare	$22.78
Rate for Payer: Hawaii Medical Service Association Medicare	$20.77
Rate for Payer: Hawaii Western Management Group Commercial	$63.65
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: Humana Medicare	$20.77
Rate for Payer: Kaiser Permanente Commercial	$60.30
Rate for Payer: Kaiser Permanente Medicaid	$34.17
Rate for Payer: Kaiser Permanente Medicare	$20.77
Rate for Payer: MDX Hawaii PPO	$64.99
Rate for Payer: Ohana Health Plan Medicaid	$20.77
Rate for Payer: Ohana Health Plan Medicare	$20.77
Rate for Payer: UnitedHealthcare Medicare	$20.77
Rate for Payer: University Health Alliance Commercial	$48.84

VORICONAZOLE 200 MG TABLET [33009]

Facility

$160.00

Service Code	NDC 68462057330
Hospital Revenue Code	250
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Kaiser Permanente Commercial	$144.00
Rate for Payer: MDX Hawaii PPO	$155.20

VORICONAZOLE 200 MG TABLET [33009]

Facility

$118.00

Service Code	NDC 60687027321
Hospital Revenue Code	250
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$70.80
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: MDX Hawaii PPO	$114.46

Know your out-of-pocket cost for care.

All Charges