KULA HOSPITAL — Hospital Ledger

45 CFR § 180 compliance

D · 65

This hospital published part of what § 180 requires.

●Machine-readable file published

●Gross / standard charges

●Discounted cash price

○Payer-specific negotiated rates

○Min / max negotiated charges

●Free, public, no login required

Procedures listed

4,794

Insurances with rates

CPT / HCPCS codes

2,728

Source MRF

csv ↗

Most expensive procedures (gross)

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
J1411	etranacogene dezaparvovec-drlb 1x10exp13 gc/mL Susp 1 Each KIT	$8,400,005	$3,276,002	—	—	0
Q2054	lisocabtagene maraleuceL 1.5 x to 70 x 10exp6 cell/mL Susp 1 Each VIAL	$1,472,908	$574,434	—	—	0
J2326	nusinersen (PF) 12 mg/5 mL Soln 5 mL VIAL	$386,234	$150,631	—	—	0
J0225	vutrisiran 25 mg/0.5 mL Syringe 0.5 mL SYRINGE	$315,092	$122,886	—	—	0
J1412	valoctocogene roxaparvovc-rvox 2 x 10exp13 vg/mL Susp 1 Each VIAL	$250,132	$97,551	—	—	0
A9513	lutetium Lu 177 dotatate 10 mCi/mL (370 MBq/mL) Soln 1 Each VIAL	$193,133	$75,322	—	—	0
J7174	fitusiran 20 mg/0.2 mL Soln 0.2 mL VIAL	$185,938	$72,516	—	—	0
Q2043	sipuleuceL-T in LR 50 million cell/250 mL Susp 250 mL BAG	$180,340	$70,333	—	—	1
J0224	lumasiran 94.5 mg/0.5 mL Soln 0.5 mL VIAL	$173,090	$67,505	—	—	0
J1747	Spesolimab-sbzo 60 mg/mL Soln 7.5 mL VIAL	$160,728	$62,684	—	—	0
A9607	"lutetium Lu-177 vipivotide tetraxetan 27 mCi/mL (1,000 MBq/mL) Soln 1 Each VIAL"	$147,409	$57,490	—	—	0
J7352	afamelanotide 16 mg Implant 1 Each VIAL	$145,183	$56,622	—	—	0
J9226	histrelin 50 mg (65 mcg/day) Kit 1 Each KIT	$144,528	$56,366	—	—	1
90288	botulism immune globulin (human) 100 mg Recon soln 1 Each VIAL	$137,525	$53,635	—	—	0
J1823	inebilizumab-cdon 10 mg/mL Soln 10 mL VIAL	$134,644	$52,511	—	—	0
187001050	sodium benzoate-sod phenylacet 10-10 % Soln 50 mL VIAL	$131,508	$51,288	—	—	0
J0223	givosiran 189 mg/mL Soln 1 mL VIAL	$126,420	$49,304	—	—	0
C9293	"glucarpidase 1,000 unit Recon soln 1 Each VIAL"	$124,516	$48,561	—	—	1
J9347	tremelimumab-actl 20 mg/mL Soln 15 mL VIAL	$119,240	$46,504	—	—	0
J2351	"ocrelizumab-hyaluronidase-ocsq 920 mg-23,000 unit/23 mL Soln 23 mL VIAL"	$118,897	$46,370	—	—	0
J9228	ipilimumab 200 mg/40 mL (5 mg/mL) Soln 40 mL VIAL	$104,355	$40,699	—	—	1
J9269	"tagraxofusp-erzs 1,000 mcg/mL Soln 1 mL VIAL"	$97,264	$37,933	—	—	0
J2507	pegloticase 8 mg/mL Soln 1 mL VIAL	$88,545	$34,532	—	—	1
A9606	"radium Ra 223 dichloride 1,100 kBq/mL(30 microcurie/mL) Soln 1 Each VIAL"	$86,651	$33,794	—	—	1
J9118	calaspargase pegol-mknl 750 unit/mL Soln 5 mL VIAL	$85,760	$33,446	—	—	0
J0202	alemtuzumab 12 mg/1.2 mL Soln 1.2 mL VIAL	$85,668	$33,411	—	—	1
187552560	Bexarotene 1 % Gel 60 g TUBE	$83,983	$32,753	—	—	0
J9359	loncastuximab tesirine-lpyL 10 mg Recon soln 1 Each VIAL	$81,612	$31,829	—	—	0
J9266	pegaspargase 750 unit/mL Soln 5 mL VIAL	$79,203	$30,889	—	—	1
J1951	leuprolide (pediatric 6 month) 45 mg Syringe 1 Each SYRINGE	$79,041	$30,826	—	—	0
J9348	naxitamab-gqgk 4 mg/mL Soln 10 mL VIAL	$75,115	$29,295	—	—	0
J9281	mitoMYcin 40 mg x 2 Kit 1 Each VIAL	$73,287	$28,582	—	—	0
J3401	Beremagene geperpavec-svdt 5 x 10exp9 PFU/2.5 mL Gel 2.5 mL VIAL	$72,667	$28,340	—	—	0
187000714	ribavirin 6 gram Recon soln 4 Each VIAL	$71,893	$28,038	—	—	0
173091301	belantamab mafodotin-blmf 70 mg Recon soln 1 Each VIAL	$69,165	$26,974	—	—	0
J1303	ravulizumab-cwvz 100 mg/mL Soln 11 mL VIAL	$68,984	$26,904	—	—	0
J9229	inotuzumab ozogamicin 0.9 mg (0.25 mg/mL initial) Recon soln 1 Each VIAL	$68,923	$26,880	—	—	0
J9600	porfimer 75 mg Recon soln 1 Each VIAL	$67,175	$26,198	—	—	1
J2327	risankizumab-rzaa 150 mg/mL Pen injector 1 mL SYRINGE	$64,469	$25,143	—	—	0
J3316	triptorelin 22.5 mg Recon susp 1 Each VIAL	$64,262	$25,062	—	—	0
J0638	canakinumab (PF) 150 mg/mL Soln 1 mL VIAL	$61,592	$24,021	—	—	1
J9274	tebentafusp-tebn 100 mcg/0.5 mL Soln 0.5 mL VIAL	$60,496	$23,594	—	—	0
J2502	pasireotide 10 mg Recon susp 1 Each VIAL	$60,260	$23,502	—	—	1
J2350	ocrelizumab 30 mg/mL Soln 10 mL VIAL	$59,451	$23,186	—	—	0
81521	ONC BREAST MRNA MICRORA GENE XPRSN PRFL 70 GENES	$57,721	$22,511	—	—	1
81541	ONC PRST8 MRNA GENE XPRSN PRFL RT-PCR 46 GENES	$57,721	$22,511	—	—	1
J1961	lenacapavir 309 mg/mL Soln 1.5 mL VIAL	$56,165	$21,904	—	—	0
J7311	Fluocinolone 0.59 mg Implant 1 Each PACKET	$54,797	$21,371	—	—	1
J9309	polatuzumab vedotin-piiq 140 mg Recon soln 1 Each VIAL	$53,646	$20,922	—	—	0
J3241	teprotumumab-trbw 500 mg Recon soln 1 Each VIAL	$51,900	$20,241	—	—	0

Showing top 50 of 4,794 priced procedures, sorted by gross charge.

Data straight from this hospital's federally-mandated machine-readable file (45 CFR § 180). The compliance grade reflects how completely the hospital published the six required data elements, not the quality of care.