Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

RISPERIDONE 0.5 MG TABLET [25520]

Facility

OP

$15.00

Service Code	NDC 68084027111
Hospital Revenue Code	637
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: University Health Alliance Commercial	$10.93

RISPERIDONE 0.5 MG TABLET [25520]

Facility

IP

$15.00

Service Code	NDC 68084027111
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: MDX Hawaii PPO	$14.55

RISPERIDONE 1 MG TABLET [18313]

Facility

OP

$16.00

Service Code	NDC 68382011414
Hospital Revenue Code	637
Min. Negotiated Rate	$8.16
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$10.08
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: University Health Alliance Commercial	$11.66

RISPERIDONE 1 MG TABLET [18313]

Facility

OP

$16.00

Service Code	NDC 68084027201
Hospital Revenue Code	637
Min. Negotiated Rate	$8.16
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$10.08
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: University Health Alliance Commercial	$11.66

RISPERIDONE 1 MG TABLET [18313]

Facility

IP

$16.00

Service Code	NDC 68382011414
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: MDX Hawaii PPO	$15.52

RISPERIDONE 1 MG TABLET [18313]

Facility

IP

$16.00

Service Code	NDC 68084027211
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: MDX Hawaii PPO	$15.52

RISPERIDONE 1 MG TABLET [18313]

Facility

IP

$16.00

Service Code	NDC 68084027201
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: MDX Hawaii PPO	$15.52

RISPERIDONE 1 MG TABLET [18313]

Facility

OP

$16.00

Service Code	NDC 68084027211
Hospital Revenue Code	637
Min. Negotiated Rate	$8.16
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$10.08
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: University Health Alliance Commercial	$11.66

RISPERIDONE 2 MG TABLET [18311]

Facility

IP

$23.00

Service Code	NDC 68084027311
Hospital Revenue Code	250
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$13.80
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: MDX Hawaii PPO	$22.31

RISPERIDONE 2 MG TABLET [18311]

Facility

OP

$23.00

Service Code	NDC 68084027301
Hospital Revenue Code	637
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$13.80
Rate for Payer: Hawaii Western Management Group Commercial	$21.85
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Kaiser Permanente Commercial	$14.49
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: University Health Alliance Commercial	$16.76

RISPERIDONE 2 MG TABLET [18311]

Facility

IP

$23.00

Service Code	NDC 68084027301
Hospital Revenue Code	250
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$13.80
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: MDX Hawaii PPO	$22.31

RISPERIDONE 2 MG TABLET [18311]

Facility

OP

$23.00

Service Code	NDC 68084027311
Hospital Revenue Code	637
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$13.80
Rate for Payer: Hawaii Western Management Group Commercial	$21.85
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Kaiser Permanente Commercial	$14.49
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: University Health Alliance Commercial	$16.76

RISPERIDONE ER 120 MG SUBCUTANEOUS EXTENDED RELEASE SUSPENSION SYRINGE [162895]

Facility

IP

$3,979.00

Service Code	HCPCS J2798
Hospital Revenue Code	250
Min. Negotiated Rate	$3,382.15
Max. Negotiated Rate	$3,859.63
Rate for Payer: Cash Price	$2,387.40
Rate for Payer: Health Management Network Commercial	$3,382.15
Rate for Payer: MDX Hawaii PPO	$3,859.63

RISPERIDONE ER 120 MG SUBCUTANEOUS EXTENDED RELEASE SUSPENSION SYRINGE [162895]

Facility

OP

$3,979.00

Service Code	HCPCS J2798
Hospital Revenue Code	636
Min. Negotiated Rate	$12.14
Max. Negotiated Rate	$3,859.63
Rate for Payer: AlohaCare Medicaid	$12.17
Rate for Payer: AlohaCare Medicare	$12.17
Rate for Payer: Cash Price	$2,387.40
Rate for Payer: Cash Price	$2,387.40
Rate for Payer: Devoted Health Medicare	$13.39
Rate for Payer: Hawaii Medical Service Association ABD	$12.14
Rate for Payer: Hawaii Medical Service Association Commercial	$15.21
Rate for Payer: Hawaii Medical Service Association Medicare	$12.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.14
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.05
Rate for Payer: Health Management Network Commercial	$3,382.15
Rate for Payer: Humana Medicare	$12.17
Rate for Payer: Kaiser Permanente Commercial	$2,506.77
Rate for Payer: Kaiser Permanente Medicaid	$2,029.29
Rate for Payer: Kaiser Permanente Medicare	$12.17
Rate for Payer: MDX Hawaii PPO	$3,859.63
Rate for Payer: Ohana Health Plan Medicaid	$13.39
Rate for Payer: Ohana Health Plan Medicare	$12.17
Rate for Payer: UnitedHealthcare Medicaid	$2,387.40
Rate for Payer: UnitedHealthcare Medicare	$12.17
Rate for Payer: University Health Alliance Commercial	$2,900.29

RISPERIDONE ER 90 MG SUBCUTANEOUS EXTENDED RELEASE SUSPENSION SYRINGE [162894]

Facility

OP

$3,109.00

Service Code	HCPCS J2798
Hospital Revenue Code	636
Min. Negotiated Rate	$12.14
Max. Negotiated Rate	$3,015.73
Rate for Payer: AlohaCare Medicaid	$12.17
Rate for Payer: AlohaCare Medicare	$12.17
Rate for Payer: Cash Price	$1,865.40
Rate for Payer: Cash Price	$1,865.40
Rate for Payer: Devoted Health Medicare	$13.39
Rate for Payer: Hawaii Medical Service Association ABD	$12.14
Rate for Payer: Hawaii Medical Service Association Commercial	$15.21
Rate for Payer: Hawaii Medical Service Association Medicare	$12.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.14
Rate for Payer: Hawaii Western Management Group Commercial	$2,953.55
Rate for Payer: Health Management Network Commercial	$2,642.65
Rate for Payer: Humana Medicare	$12.17
Rate for Payer: Kaiser Permanente Commercial	$1,958.67
Rate for Payer: Kaiser Permanente Medicaid	$1,585.59
Rate for Payer: Kaiser Permanente Medicare	$12.17
Rate for Payer: MDX Hawaii PPO	$3,015.73
Rate for Payer: Ohana Health Plan Medicaid	$13.39
Rate for Payer: Ohana Health Plan Medicare	$12.17
Rate for Payer: UnitedHealthcare Medicaid	$1,865.40
Rate for Payer: UnitedHealthcare Medicare	$12.17
Rate for Payer: University Health Alliance Commercial	$2,266.15

RISPERIDONE ER 90 MG SUBCUTANEOUS EXTENDED RELEASE SUSPENSION SYRINGE [162894]

Facility

IP

$3,109.00

Service Code	HCPCS J2798
Hospital Revenue Code	250
Min. Negotiated Rate	$2,642.65
Max. Negotiated Rate	$3,015.73
Rate for Payer: Cash Price	$1,865.40
Rate for Payer: Health Management Network Commercial	$2,642.65
Rate for Payer: MDX Hawaii PPO	$3,015.73

RISPERIDONE MICROSPHERES ER 37.5 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEAS [168908]

Facility

OP

$1,662.00

Service Code	HCPCS J2801
Hospital Revenue Code	636
Min. Negotiated Rate	$13.03
Max. Negotiated Rate	$1,612.14
Rate for Payer: AlohaCare Medicaid	$13.03
Rate for Payer: AlohaCare Medicare	$13.03
Rate for Payer: Cash Price	$997.20
Rate for Payer: Cash Price	$997.20
Rate for Payer: Devoted Health Medicare	$14.33
Rate for Payer: Hawaii Medical Service Association Commercial	$16.29
Rate for Payer: Hawaii Medical Service Association Medicare	$13.03
Rate for Payer: Hawaii Western Management Group Commercial	$1,578.90
Rate for Payer: Health Management Network Commercial	$1,412.70
Rate for Payer: Humana Medicare	$13.03
Rate for Payer: Kaiser Permanente Commercial	$1,047.06
Rate for Payer: Kaiser Permanente Medicaid	$847.62
Rate for Payer: Kaiser Permanente Medicare	$13.03
Rate for Payer: MDX Hawaii PPO	$1,612.14
Rate for Payer: Ohana Health Plan Medicaid	$14.33
Rate for Payer: Ohana Health Plan Medicare	$13.03
Rate for Payer: UnitedHealthcare Medicaid	$997.20
Rate for Payer: UnitedHealthcare Medicare	$13.03
Rate for Payer: University Health Alliance Commercial	$1,211.43

RISPERIDONE MICROSPHERES ER 37.5 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEAS [168908]

Facility

IP

$1,662.00

Service Code	HCPCS J2801
Hospital Revenue Code	250
Min. Negotiated Rate	$1,412.70
Max. Negotiated Rate	$1,612.14
Rate for Payer: Cash Price	$997.20
Rate for Payer: Health Management Network Commercial	$1,412.70
Rate for Payer: MDX Hawaii PPO	$1,612.14

RISPERIDONE MICROSPHERES ER 50 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEASE [168909]

Facility

OP

$2,049.00

Service Code	HCPCS J2801
Hospital Revenue Code	636
Min. Negotiated Rate	$13.03
Max. Negotiated Rate	$1,987.53
Rate for Payer: AlohaCare Medicaid	$13.03
Rate for Payer: AlohaCare Medicare	$13.03
Rate for Payer: Cash Price	$1,229.40
Rate for Payer: Cash Price	$1,229.40
Rate for Payer: Devoted Health Medicare	$14.33
Rate for Payer: Hawaii Medical Service Association Commercial	$16.29
Rate for Payer: Hawaii Medical Service Association Medicare	$13.03
Rate for Payer: Hawaii Western Management Group Commercial	$1,946.55
Rate for Payer: Health Management Network Commercial	$1,741.65
Rate for Payer: Humana Medicare	$13.03
Rate for Payer: Kaiser Permanente Commercial	$1,290.87
Rate for Payer: Kaiser Permanente Medicaid	$1,044.99
Rate for Payer: Kaiser Permanente Medicare	$13.03
Rate for Payer: MDX Hawaii PPO	$1,987.53
Rate for Payer: Ohana Health Plan Medicaid	$14.33
Rate for Payer: Ohana Health Plan Medicare	$13.03
Rate for Payer: UnitedHealthcare Medicaid	$1,229.40
Rate for Payer: UnitedHealthcare Medicare	$13.03
Rate for Payer: University Health Alliance Commercial	$1,493.52

RISPERIDONE MICROSPHERES ER 50 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEASE [168909]

Facility

IP

$2,049.00

Service Code	HCPCS J2801
Hospital Revenue Code	250
Min. Negotiated Rate	$1,741.65
Max. Negotiated Rate	$1,987.53
Rate for Payer: Cash Price	$1,229.40
Rate for Payer: Health Management Network Commercial	$1,741.65
Rate for Payer: MDX Hawaii PPO	$1,987.53

RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [129647]

Facility

OP

$1,692.00

Service Code	HCPCS J9312
Hospital Revenue Code	636
Min. Negotiated Rate	$74.16
Max. Negotiated Rate	$1,641.24
Rate for Payer: AlohaCare Medicaid	$74.16
Rate for Payer: AlohaCare Medicaid	$74.16
Rate for Payer: AlohaCare Medicare	$74.16
Rate for Payer: AlohaCare Medicare	$74.16
Rate for Payer: Cash Price	$1,015.20
Rate for Payer: Cash Price	$5,073.60
Rate for Payer: Cash Price	$5,073.60
Rate for Payer: Cash Price	$1,015.20
Rate for Payer: Devoted Health Medicare	$81.58
Rate for Payer: Devoted Health Medicare	$81.58
Rate for Payer: Hawaii Medical Service Association ABD	$75.93
Rate for Payer: Hawaii Medical Service Association ABD	$75.93
Rate for Payer: Hawaii Medical Service Association Commercial	$92.70
Rate for Payer: Hawaii Medical Service Association Commercial	$92.70
Rate for Payer: Hawaii Medical Service Association Medicare	$74.16
Rate for Payer: Hawaii Medical Service Association Medicare	$74.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$75.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$75.93
Rate for Payer: Hawaii Western Management Group Commercial	$8,033.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,607.40
Rate for Payer: Health Management Network Commercial	$7,187.60
Rate for Payer: Health Management Network Commercial	$1,438.20
Rate for Payer: Humana Medicare	$74.16
Rate for Payer: Humana Medicare	$74.16
Rate for Payer: Kaiser Permanente Commercial	$5,327.28
Rate for Payer: Kaiser Permanente Commercial	$1,065.96
Rate for Payer: Kaiser Permanente Medicaid	$4,312.56
Rate for Payer: Kaiser Permanente Medicaid	$862.92
Rate for Payer: Kaiser Permanente Medicare	$74.16
Rate for Payer: Kaiser Permanente Medicare	$74.16
Rate for Payer: MDX Hawaii PPO	$8,202.32
Rate for Payer: MDX Hawaii PPO	$1,641.24
Rate for Payer: Ohana Health Plan Medicaid	$81.58
Rate for Payer: Ohana Health Plan Medicaid	$81.58
Rate for Payer: Ohana Health Plan Medicare	$74.16
Rate for Payer: Ohana Health Plan Medicare	$74.16
Rate for Payer: UnitedHealthcare Medicaid	$1,015.20
Rate for Payer: UnitedHealthcare Medicaid	$5,073.60
Rate for Payer: UnitedHealthcare Medicare	$74.16
Rate for Payer: UnitedHealthcare Medicare	$74.16
Rate for Payer: University Health Alliance Commercial	$1,233.30
Rate for Payer: University Health Alliance Commercial	$6,163.58

RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [129647]

Facility

IP

$1,692.00

Service Code	HCPCS J9312
Hospital Revenue Code	250
Min. Negotiated Rate	$1,438.20
Max. Negotiated Rate	$1,641.24
Rate for Payer: Cash Price	$1,015.20
Rate for Payer: Cash Price	$5,073.60
Rate for Payer: Health Management Network Commercial	$1,438.20
Rate for Payer: Health Management Network Commercial	$7,187.60
Rate for Payer: MDX Hawaii PPO	$1,641.24
Rate for Payer: MDX Hawaii PPO	$8,202.32

RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [139634]

Facility

IP

$11,838.00

Service Code	HCPCS J9311
Hospital Revenue Code	250
Min. Negotiated Rate	$10,062.30
Max. Negotiated Rate	$11,482.86
Rate for Payer: Cash Price	$7,102.80
Rate for Payer: Health Management Network Commercial	$10,062.30
Rate for Payer: MDX Hawaii PPO	$11,482.86

RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [139634]

Facility

OP

$11,838.00

Service Code	HCPCS J9311
Hospital Revenue Code	636
Min. Negotiated Rate	$36.28
Max. Negotiated Rate	$11,482.86
Rate for Payer: AlohaCare Medicaid	$36.28
Rate for Payer: AlohaCare Medicare	$36.28
Rate for Payer: Cash Price	$7,102.80
Rate for Payer: Cash Price	$7,102.80
Rate for Payer: Devoted Health Medicare	$39.91
Rate for Payer: Hawaii Medical Service Association ABD	$36.96
Rate for Payer: Hawaii Medical Service Association Commercial	$45.35
Rate for Payer: Hawaii Medical Service Association Medicare	$36.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.96
Rate for Payer: Hawaii Western Management Group Commercial	$11,246.10
Rate for Payer: Health Management Network Commercial	$10,062.30
Rate for Payer: Humana Medicare	$36.28
Rate for Payer: Kaiser Permanente Commercial	$7,457.94
Rate for Payer: Kaiser Permanente Medicaid	$6,037.38
Rate for Payer: Kaiser Permanente Medicare	$36.28
Rate for Payer: MDX Hawaii PPO	$11,482.86
Rate for Payer: Ohana Health Plan Medicaid	$39.91
Rate for Payer: Ohana Health Plan Medicare	$36.28
Rate for Payer: UnitedHealthcare Medicaid	$7,102.80
Rate for Payer: UnitedHealthcare Medicare	$36.28
Rate for Payer: University Health Alliance Commercial	$8,628.72

RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [139635]

Facility

IP

$13,529.00

Service Code	HCPCS J9311
Hospital Revenue Code	250
Min. Negotiated Rate	$11,499.65
Max. Negotiated Rate	$13,123.13
Rate for Payer: Cash Price	$8,117.40
Rate for Payer: Health Management Network Commercial	$11,499.65
Rate for Payer: MDX Hawaii PPO	$13,123.13

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