Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

ROMIPLOSTIM 250 MCG/0.5ML SC (WET SOLR VIAL) [43093566]

Facility

$1,069.00

Service Code	HCPCS J2796
Hospital Revenue Code	250
Min. Negotiated Rate	$908.65
Max. Negotiated Rate	$1,036.93
Rate for Payer: Cash Price	$641.40
Rate for Payer: Cash Price	$2,282.40
Rate for Payer: Health Management Network Commercial	$3,233.40
Rate for Payer: Health Management Network Commercial	$908.65
Rate for Payer: MDX Hawaii PPO	$1,036.93
Rate for Payer: MDX Hawaii PPO	$3,689.88

ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION [93566]

Facility

$3,804.00

Service Code	HCPCS J2802
Hospital Revenue Code	636
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$3,689.88
Rate for Payer: AlohaCare Medicaid	$11.11
Rate for Payer: AlohaCare Medicare	$11.11
Rate for Payer: Cash Price	$2,282.40
Rate for Payer: Cash Price	$2,282.40
Rate for Payer: Devoted Health Medicare	$12.22
Rate for Payer: Hawaii Medical Service Association ABD	$11.00
Rate for Payer: Hawaii Medical Service Association Commercial	$13.89
Rate for Payer: Hawaii Medical Service Association Medicare	$11.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,613.80
Rate for Payer: Health Management Network Commercial	$3,233.40
Rate for Payer: Humana Medicare	$11.11
Rate for Payer: Kaiser Permanente Commercial	$2,396.52
Rate for Payer: Kaiser Permanente Medicaid	$1,940.04
Rate for Payer: Kaiser Permanente Medicare	$11.11
Rate for Payer: MDX Hawaii PPO	$3,689.88
Rate for Payer: Ohana Health Plan Medicaid	$12.22
Rate for Payer: Ohana Health Plan Medicare	$11.11
Rate for Payer: UnitedHealthcare Medicaid	$2,282.40
Rate for Payer: UnitedHealthcare Medicare	$11.11
Rate for Payer: University Health Alliance Commercial	$2,772.74

ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION [93566]

Facility

$3,804.00

Service Code	HCPCS J2802
Hospital Revenue Code	250
Min. Negotiated Rate	$3,233.40
Max. Negotiated Rate	$3,689.88
Rate for Payer: Cash Price	$2,282.40
Rate for Payer: Health Management Network Commercial	$3,233.40
Rate for Payer: MDX Hawaii PPO	$3,689.88

ROMIPLOSTIM 500 MCG/ML SC (WET SOLR VIAL) [43093567]

Facility

$7,108.00

Service Code	HCPCS J2796
Hospital Revenue Code	250
Min. Negotiated Rate	$6,041.80
Max. Negotiated Rate	$6,894.76
Rate for Payer: Cash Price	$4,264.80
Rate for Payer: Health Management Network Commercial	$6,041.80
Rate for Payer: MDX Hawaii PPO	$6,894.76

ROMIPLOSTIM 500 MCG/ML SC (WET SOLR VIAL) [43093567]

Facility

$7,108.00

Service Code	HCPCS J2796
Hospital Revenue Code	636
Min. Negotiated Rate	$101.05
Max. Negotiated Rate	$6,894.76
Rate for Payer: Cash Price	$4,264.80
Rate for Payer: Cash Price	$4,264.80
Rate for Payer: Hawaii Medical Service Association ABD	$101.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$101.05
Rate for Payer: Hawaii Western Management Group Commercial	$6,752.60
Rate for Payer: Health Management Network Commercial	$6,041.80
Rate for Payer: Kaiser Permanente Commercial	$4,478.04
Rate for Payer: Kaiser Permanente Medicaid	$3,625.08
Rate for Payer: MDX Hawaii PPO	$6,894.76
Rate for Payer: UnitedHealthcare Medicaid	$4,264.80
Rate for Payer: University Health Alliance Commercial	$5,181.02

ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION [93567]

Facility

$7,108.00

Service Code	HCPCS J2802
Hospital Revenue Code	636
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$6,894.76
Rate for Payer: Kaiser Permanente Commercial	$4,478.04
Rate for Payer: AlohaCare Medicaid	$11.11
Rate for Payer: AlohaCare Medicare	$11.11
Rate for Payer: Cash Price	$4,264.80
Rate for Payer: Cash Price	$4,264.80
Rate for Payer: Devoted Health Medicare	$12.22
Rate for Payer: Hawaii Medical Service Association ABD	$11.00
Rate for Payer: Hawaii Medical Service Association Commercial	$13.89
Rate for Payer: Hawaii Medical Service Association Medicare	$11.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,752.60
Rate for Payer: Health Management Network Commercial	$6,041.80
Rate for Payer: Humana Medicare	$11.11
Rate for Payer: Kaiser Permanente Medicaid	$3,625.08
Rate for Payer: Kaiser Permanente Medicare	$11.11
Rate for Payer: MDX Hawaii PPO	$6,894.76
Rate for Payer: Ohana Health Plan Medicaid	$12.22
Rate for Payer: Ohana Health Plan Medicare	$11.11
Rate for Payer: UnitedHealthcare Medicaid	$4,264.80
Rate for Payer: UnitedHealthcare Medicare	$11.11
Rate for Payer: University Health Alliance Commercial	$5,181.02

ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION [93567]

Facility

$7,108.00

Service Code	HCPCS J2802
Hospital Revenue Code	250
Min. Negotiated Rate	$6,041.80
Max. Negotiated Rate	$6,894.76
Rate for Payer: Cash Price	$4,264.80
Rate for Payer: Health Management Network Commercial	$6,041.80
Rate for Payer: MDX Hawaii PPO	$6,894.76

ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE [167848]

Facility

$2,078.00

Service Code	HCPCS J3111
Hospital Revenue Code	636
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$2,015.66
Rate for Payer: AlohaCare Medicaid	$12.19
Rate for Payer: AlohaCare Medicare	$12.19
Rate for Payer: Cash Price	$1,246.80
Rate for Payer: Cash Price	$1,246.80
Rate for Payer: Devoted Health Medicare	$13.41
Rate for Payer: Hawaii Medical Service Association ABD	$12.00
Rate for Payer: Hawaii Medical Service Association Commercial	$15.24
Rate for Payer: Hawaii Medical Service Association Medicare	$12.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.10
Rate for Payer: Health Management Network Commercial	$1,766.30
Rate for Payer: Humana Medicare	$12.19
Rate for Payer: Kaiser Permanente Commercial	$1,309.14
Rate for Payer: Kaiser Permanente Medicaid	$1,059.78
Rate for Payer: Kaiser Permanente Medicare	$12.19
Rate for Payer: MDX Hawaii PPO	$2,015.66
Rate for Payer: Ohana Health Plan Medicaid	$13.41
Rate for Payer: Ohana Health Plan Medicare	$12.19
Rate for Payer: UnitedHealthcare Medicaid	$1,246.80
Rate for Payer: UnitedHealthcare Medicare	$12.19
Rate for Payer: University Health Alliance Commercial	$1,514.65

ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE [167848]

Facility

$2,078.00

Service Code	HCPCS J3111
Hospital Revenue Code	250
Min. Negotiated Rate	$1,766.30
Max. Negotiated Rate	$2,015.66
Rate for Payer: Cash Price	$1,246.80
Rate for Payer: Health Management Network Commercial	$1,766.30
Rate for Payer: MDX Hawaii PPO	$2,015.66

ROOKE BOOT BK PROTECTOR BK-406

Facility

$977.00

Hospital Revenue Code	271
Min. Negotiated Rate	$830.45
Max. Negotiated Rate	$947.69
Rate for Payer: Cash Price	$586.20
Rate for Payer: Health Management Network Commercial	$830.45
Rate for Payer: MDX Hawaii PPO	$947.69

ROOKE BOOT BK PROTECTOR BK-406

Facility

$977.00

Hospital Revenue Code	271
Min. Negotiated Rate	$498.27
Max. Negotiated Rate	$947.69
Rate for Payer: Cash Price	$586.20
Rate for Payer: Hawaii Western Management Group Commercial	$928.15
Rate for Payer: Health Management Network Commercial	$830.45
Rate for Payer: Kaiser Permanente Commercial	$615.51
Rate for Payer: Kaiser Permanente Medicaid	$498.27
Rate for Payer: MDX Hawaii PPO	$947.69
Rate for Payer: University Health Alliance Commercial	$712.14

ROPEGINTERFERON ALFA-2B-NJFT 500 MCG/ML SUBCUTANEOUS SYRINGE [182609]

Facility

$11,528.00

Service Code	HCPCS J3590
Hospital Revenue Code	250
Min. Negotiated Rate	$9,798.80
Max. Negotiated Rate	$11,182.16
Rate for Payer: Cash Price	$6,916.80
Rate for Payer: Health Management Network Commercial	$9,798.80
Rate for Payer: MDX Hawaii PPO	$11,182.16

ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]

Facility

$34.00

Service Code	HCPCS J2795
Hospital Revenue Code	250
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$20.40
Rate for Payer: Cash Price	$19.80
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: MDX Hawaii PPO	$32.01

ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]

Facility

$33.00

Service Code	HCPCS J2795
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$20.40
Rate for Payer: Cash Price	$20.40
Rate for Payer: Hawaii Medical Service Association ABD	$0.06
Rate for Payer: Hawaii Medical Service Association ABD	$0.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.06
Rate for Payer: Hawaii Western Management Group Commercial	$31.35
Rate for Payer: Hawaii Western Management Group Commercial	$32.30
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$20.79
Rate for Payer: Kaiser Permanente Commercial	$21.42
Rate for Payer: Kaiser Permanente Medicaid	$17.34
Rate for Payer: Kaiser Permanente Medicaid	$16.83
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: MDX Hawaii PPO	$32.01
Rate for Payer: UnitedHealthcare Medicaid	$19.80
Rate for Payer: UnitedHealthcare Medicaid	$20.40
Rate for Payer: University Health Alliance Commercial	$24.05
Rate for Payer: University Health Alliance Commercial	$24.78

ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]

Facility

$34.00

Service Code	HCPCS J2795
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$20.40
Rate for Payer: Cash Price	$57.00
Rate for Payer: Cash Price	$20.40
Rate for Payer: Cash Price	$57.00
Rate for Payer: Hawaii Medical Service Association ABD	$0.06
Rate for Payer: Hawaii Medical Service Association ABD	$0.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.06
Rate for Payer: Hawaii Western Management Group Commercial	$90.25
Rate for Payer: Hawaii Western Management Group Commercial	$32.30
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$59.85
Rate for Payer: Kaiser Permanente Commercial	$21.42
Rate for Payer: Kaiser Permanente Medicaid	$17.34
Rate for Payer: Kaiser Permanente Medicaid	$48.45
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: MDX Hawaii PPO	$92.15
Rate for Payer: UnitedHealthcare Medicaid	$57.00
Rate for Payer: UnitedHealthcare Medicaid	$20.40
Rate for Payer: University Health Alliance Commercial	$24.78
Rate for Payer: University Health Alliance Commercial	$69.25

ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]

Facility

$34.00

Service Code	HCPCS J2795
Hospital Revenue Code	250
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$20.40
Rate for Payer: Cash Price	$57.00
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: MDX Hawaii PPO	$92.15

ROSEN CRVED WIRE GUIDE

Facility

$95.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$80.75
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$57.00
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: MDX Hawaii PPO	$92.15

ROSEN CRVED WIRE GUIDE

Facility

$95.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$57.00
Rate for Payer: Hawaii Western Management Group Commercial	$90.25
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Kaiser Permanente Commercial	$59.85
Rate for Payer: Kaiser Permanente Medicaid	$48.45
Rate for Payer: MDX Hawaii PPO	$92.15
Rate for Payer: University Health Alliance Commercial	$69.25

ROSUVASTATIN 20 MG TABLET [35135]

Facility

$6.00

Service Code	NDC 50268071015
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: MDX Hawaii PPO	$5.82

ROSUVASTATIN 20 MG TABLET [35135]

Facility

$6.00

Service Code	NDC 50268071015
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$3.78
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: University Health Alliance Commercial	$4.37

ROSUVASTATIN 20 MG TABLET [35135]

Facility

$6.00

Service Code	NDC 50268071011
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$3.78
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: University Health Alliance Commercial	$4.37

ROSUVASTATIN 20 MG TABLET [35135]

Facility

$6.00

Service Code	NDC 50268071011
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: MDX Hawaii PPO	$5.82

ROSUVASTATIN 40 MG TABLET [35136]

Facility

$6.00

Service Code	NDC 50268071115
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: MDX Hawaii PPO	$5.82

ROSUVASTATIN 40 MG TABLET [35136]

Facility

$6.00

Service Code	NDC 50268071111
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: MDX Hawaii PPO	$5.82

ROSUVASTATIN 40 MG TABLET [35136]

Facility

$6.00

Service Code	NDC 50268071111
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$3.78
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: University Health Alliance Commercial	$4.37

Know your out-of-pocket cost for care.

All Charges