Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

rimegepant 75 mg DIS tablet [KMC]

Facility

$510.00

Service Code	NDC 72618300002
Hospital Revenue Code	250
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$494.70
Rate for Payer: AlohaCare Medicaid	$255.00
Rate for Payer: AlohaCare Medicare	$214.20
Rate for Payer: Cash Price	$331.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$469.20
Rate for Payer: Devoted Health Medicare	$214.20
Rate for Payer: Hawaii Medical Service Association Medicare	$214.20
Rate for Payer: Hawaii Western Management Group Commercial	$484.50
Rate for Payer: Health Management Network Commercial	$433.50
Rate for Payer: Humana Medicare	$214.20
Rate for Payer: Kaiser Permanente Commercial	$459.00
Rate for Payer: Kaiser Permanente Medicaid	$260.10
Rate for Payer: Kaiser Permanente Medicare	$214.20
Rate for Payer: MDX Hawaii PPO	$494.70
Rate for Payer: Ohana Health Plan Medicaid	$214.20
Rate for Payer: Ohana Health Plan Medicare	$214.20
Rate for Payer: UnitedHealthcare Medicaid	$306.00
Rate for Payer: UnitedHealthcare Medicare	$214.20
Rate for Payer: University Health Alliance Commercial	$371.74

risedronate 150 mg Tab [KMC]

Facility

$933.60

Service Code	NDC 59762040601
Hospital Revenue Code	250
Min. Negotiated Rate	$793.56
Max. Negotiated Rate	$905.59
Rate for Payer: Cash Price	$606.84
Rate for Payer: Health Management Network Commercial	$793.56
Rate for Payer: Kaiser Permanente Commercial	$840.24
Rate for Payer: MDX Hawaii PPO	$905.59

risedronate 150 mg Tab [KMC]

Facility

$933.60

Service Code	NDC 59762040601
Hospital Revenue Code	250
Min. Negotiated Rate	$392.11
Max. Negotiated Rate	$905.59
Rate for Payer: AlohaCare Medicaid	$466.80
Rate for Payer: AlohaCare Medicare	$392.11
Rate for Payer: Cash Price	$606.84
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$858.91
Rate for Payer: Devoted Health Medicare	$392.11
Rate for Payer: Hawaii Medical Service Association Medicare	$392.11
Rate for Payer: Hawaii Western Management Group Commercial	$886.92
Rate for Payer: Health Management Network Commercial	$793.56
Rate for Payer: Humana Medicare	$392.11
Rate for Payer: Kaiser Permanente Commercial	$840.24
Rate for Payer: Kaiser Permanente Medicaid	$476.14
Rate for Payer: Kaiser Permanente Medicare	$392.11
Rate for Payer: MDX Hawaii PPO	$905.59
Rate for Payer: Ohana Health Plan Medicaid	$392.11
Rate for Payer: Ohana Health Plan Medicare	$392.11
Rate for Payer: UnitedHealthcare Medicaid	$560.16
Rate for Payer: UnitedHealthcare Medicare	$392.11
Rate for Payer: University Health Alliance Commercial	$680.50

risedronate 35 mg EC[KMC]

Facility

$185.62

Service Code	NDC 00430097903
Hospital Revenue Code	250
Min. Negotiated Rate	$77.96
Max. Negotiated Rate	$180.05
Rate for Payer: AlohaCare Medicaid	$92.81
Rate for Payer: AlohaCare Medicare	$77.96
Rate for Payer: Cash Price	$120.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$170.77
Rate for Payer: Devoted Health Medicare	$77.96
Rate for Payer: Hawaii Medical Service Association Medicare	$77.96
Rate for Payer: Hawaii Western Management Group Commercial	$176.34
Rate for Payer: Health Management Network Commercial	$157.78
Rate for Payer: Humana Medicare	$77.96
Rate for Payer: Kaiser Permanente Commercial	$167.06
Rate for Payer: Kaiser Permanente Medicaid	$94.67
Rate for Payer: Kaiser Permanente Medicare	$77.96
Rate for Payer: MDX Hawaii PPO	$180.05
Rate for Payer: Ohana Health Plan Medicaid	$77.96
Rate for Payer: Ohana Health Plan Medicare	$77.96
Rate for Payer: UnitedHealthcare Medicaid	$111.37
Rate for Payer: UnitedHealthcare Medicare	$77.96
Rate for Payer: University Health Alliance Commercial	$135.30

risedronate 35 mg EC[KMC]

Facility

$185.62

Service Code	NDC 00430097903
Hospital Revenue Code	250
Min. Negotiated Rate	$157.78
Max. Negotiated Rate	$180.05
Rate for Payer: Cash Price	$120.65
Rate for Payer: Health Management Network Commercial	$157.78
Rate for Payer: Kaiser Permanente Commercial	$167.06
Rate for Payer: MDX Hawaii PPO	$180.05

risedronate 35 mg Tab [KMC]

Facility

$208.18

Service Code	NDC 00430047203
Hospital Revenue Code	250
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$201.93
Rate for Payer: AlohaCare Medicaid	$104.09
Rate for Payer: AlohaCare Medicare	$87.44
Rate for Payer: Cash Price	$135.32
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$191.53
Rate for Payer: Devoted Health Medicare	$87.44
Rate for Payer: Hawaii Medical Service Association Medicare	$87.44
Rate for Payer: Hawaii Western Management Group Commercial	$197.77
Rate for Payer: Health Management Network Commercial	$176.95
Rate for Payer: Humana Medicare	$87.44
Rate for Payer: Kaiser Permanente Commercial	$187.36
Rate for Payer: Kaiser Permanente Medicaid	$106.17
Rate for Payer: Kaiser Permanente Medicare	$87.44
Rate for Payer: MDX Hawaii PPO	$201.93
Rate for Payer: Ohana Health Plan Medicaid	$87.44
Rate for Payer: Ohana Health Plan Medicare	$87.44
Rate for Payer: UnitedHealthcare Medicaid	$124.91
Rate for Payer: UnitedHealthcare Medicare	$87.44
Rate for Payer: University Health Alliance Commercial	$151.74

risedronate 35 mg Tab [KMC]

Facility

$208.18

Service Code	NDC 00430047203
Hospital Revenue Code	250
Min. Negotiated Rate	$176.95
Max. Negotiated Rate	$201.93
Rate for Payer: Cash Price	$135.32
Rate for Payer: Health Management Network Commercial	$176.95
Rate for Payer: Kaiser Permanente Commercial	$187.36
Rate for Payer: MDX Hawaii PPO	$201.93

risperiDONE 0.25 mg Tab [KMC]

Facility

$15.61

Service Code	NDC 00603568320
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$15.14
Rate for Payer: AlohaCare Medicaid	$7.80
Rate for Payer: AlohaCare Medicare	$6.56
Rate for Payer: Cash Price	$10.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$14.36
Rate for Payer: Devoted Health Medicare	$6.56
Rate for Payer: Hawaii Medical Service Association Medicare	$6.56
Rate for Payer: Hawaii Western Management Group Commercial	$14.83
Rate for Payer: Health Management Network Commercial	$13.27
Rate for Payer: Humana Medicare	$6.56
Rate for Payer: Kaiser Permanente Commercial	$14.05
Rate for Payer: Kaiser Permanente Medicaid	$7.96
Rate for Payer: Kaiser Permanente Medicare	$6.56
Rate for Payer: MDX Hawaii PPO	$15.14
Rate for Payer: Ohana Health Plan Medicaid	$6.56
Rate for Payer: Ohana Health Plan Medicare	$6.56
Rate for Payer: UnitedHealthcare Medicaid	$9.37
Rate for Payer: UnitedHealthcare Medicare	$6.56
Rate for Payer: University Health Alliance Commercial	$11.38

risperiDONE 0.25 mg Tab [KMC]

Facility

$15.61

Service Code	NDC 00603568320
Hospital Revenue Code	250
Min. Negotiated Rate	$13.27
Max. Negotiated Rate	$15.14
Rate for Payer: Cash Price	$10.15
Rate for Payer: Health Management Network Commercial	$13.27
Rate for Payer: Kaiser Permanente Commercial	$14.05
Rate for Payer: MDX Hawaii PPO	$15.14

risperiDONE 0.5 mg ODT tab [KMC]

Facility

$19.67

Service Code	NDC 59746001032
Hospital Revenue Code	250
Min. Negotiated Rate	$16.72
Max. Negotiated Rate	$19.08
Rate for Payer: Cash Price	$12.79
Rate for Payer: Health Management Network Commercial	$16.72
Rate for Payer: Kaiser Permanente Commercial	$17.70
Rate for Payer: MDX Hawaii PPO	$19.08

risperiDONE 0.5 mg ODT tab [KMC]

Facility

$19.67

Service Code	NDC 59746001032
Hospital Revenue Code	250
Min. Negotiated Rate	$8.26
Max. Negotiated Rate	$19.08
Rate for Payer: AlohaCare Medicaid	$9.84
Rate for Payer: AlohaCare Medicare	$8.26
Rate for Payer: Cash Price	$12.79
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$18.10
Rate for Payer: Devoted Health Medicare	$8.26
Rate for Payer: Hawaii Medical Service Association Medicare	$8.26
Rate for Payer: Hawaii Western Management Group Commercial	$18.69
Rate for Payer: Health Management Network Commercial	$16.72
Rate for Payer: Humana Medicare	$8.26
Rate for Payer: Kaiser Permanente Commercial	$17.70
Rate for Payer: Kaiser Permanente Medicaid	$10.03
Rate for Payer: Kaiser Permanente Medicare	$8.26
Rate for Payer: MDX Hawaii PPO	$19.08
Rate for Payer: Ohana Health Plan Medicaid	$8.26
Rate for Payer: Ohana Health Plan Medicare	$8.26
Rate for Payer: UnitedHealthcare Medicaid	$11.80
Rate for Payer: UnitedHealthcare Medicare	$8.26
Rate for Payer: University Health Alliance Commercial	$14.34

risperiDONE 0.5 mg Tab [KMC]

Facility

$17.12

Service Code	NDC 00603568420
Hospital Revenue Code	250
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$16.61
Rate for Payer: Cash Price	$11.13
Rate for Payer: Health Management Network Commercial	$14.55
Rate for Payer: Kaiser Permanente Commercial	$15.41
Rate for Payer: MDX Hawaii PPO	$16.61

risperiDONE 0.5 mg Tab [KMC]

Facility

$17.12

Service Code	NDC 00603568420
Hospital Revenue Code	250
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$16.61
Rate for Payer: AlohaCare Medicaid	$8.56
Rate for Payer: AlohaCare Medicare	$7.19
Rate for Payer: Cash Price	$11.13
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$15.75
Rate for Payer: Devoted Health Medicare	$7.19
Rate for Payer: Hawaii Medical Service Association Medicare	$7.19
Rate for Payer: Hawaii Western Management Group Commercial	$16.26
Rate for Payer: Health Management Network Commercial	$14.55
Rate for Payer: Humana Medicare	$7.19
Rate for Payer: Kaiser Permanente Commercial	$15.41
Rate for Payer: Kaiser Permanente Medicaid	$8.73
Rate for Payer: Kaiser Permanente Medicare	$7.19
Rate for Payer: MDX Hawaii PPO	$16.61
Rate for Payer: Ohana Health Plan Medicaid	$7.19
Rate for Payer: Ohana Health Plan Medicare	$7.19
Rate for Payer: UnitedHealthcare Medicaid	$10.27
Rate for Payer: UnitedHealthcare Medicare	$7.19
Rate for Payer: University Health Alliance Commercial	$12.48

risperiDONE 1 mg/mL Oral Soln [KMC]

Facility

$20.31

Service Code	NDC 65162067384
Hospital Revenue Code	250
Min. Negotiated Rate	$17.26
Max. Negotiated Rate	$19.70
Rate for Payer: Cash Price	$13.20
Rate for Payer: Health Management Network Commercial	$17.26
Rate for Payer: Kaiser Permanente Commercial	$18.28
Rate for Payer: MDX Hawaii PPO	$19.70

risperiDONE 1 mg/mL Oral Soln [KMC]

Facility

$20.31

Service Code	NDC 65162067384
Hospital Revenue Code	250
Min. Negotiated Rate	$8.53
Max. Negotiated Rate	$19.70
Rate for Payer: AlohaCare Medicaid	$10.15
Rate for Payer: AlohaCare Medicare	$8.53
Rate for Payer: Cash Price	$13.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$18.69
Rate for Payer: Devoted Health Medicare	$8.53
Rate for Payer: Hawaii Medical Service Association Medicare	$8.53
Rate for Payer: Hawaii Western Management Group Commercial	$19.29
Rate for Payer: Health Management Network Commercial	$17.26
Rate for Payer: Humana Medicare	$8.53
Rate for Payer: Kaiser Permanente Commercial	$18.28
Rate for Payer: Kaiser Permanente Medicaid	$10.36
Rate for Payer: Kaiser Permanente Medicare	$8.53
Rate for Payer: MDX Hawaii PPO	$19.70
Rate for Payer: Ohana Health Plan Medicaid	$8.53
Rate for Payer: Ohana Health Plan Medicare	$8.53
Rate for Payer: UnitedHealthcare Medicaid	$12.19
Rate for Payer: UnitedHealthcare Medicare	$8.53
Rate for Payer: University Health Alliance Commercial	$14.80

risperiDONE 1 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00904736261
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

risperiDONE 1 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00904736261
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

risperiDONE 2 mg DIS tablet [KMC]

Facility

$35.78

Service Code	NDC 59746003022
Hospital Revenue Code	250
Min. Negotiated Rate	$30.41
Max. Negotiated Rate	$34.71
Rate for Payer: Cash Price	$23.26
Rate for Payer: Health Management Network Commercial	$30.41
Rate for Payer: Kaiser Permanente Commercial	$32.20
Rate for Payer: MDX Hawaii PPO	$34.71

risperiDONE 2 mg DIS tablet [KMC]

Facility

$35.78

Service Code	NDC 59746003022
Hospital Revenue Code	250
Min. Negotiated Rate	$15.03
Max. Negotiated Rate	$34.71
Rate for Payer: AlohaCare Medicaid	$17.89
Rate for Payer: AlohaCare Medicare	$15.03
Rate for Payer: Cash Price	$23.26
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$32.92
Rate for Payer: Devoted Health Medicare	$15.03
Rate for Payer: Hawaii Medical Service Association Medicare	$15.03
Rate for Payer: Hawaii Western Management Group Commercial	$33.99
Rate for Payer: Health Management Network Commercial	$30.41
Rate for Payer: Humana Medicare	$15.03
Rate for Payer: Kaiser Permanente Commercial	$32.20
Rate for Payer: Kaiser Permanente Medicaid	$18.25
Rate for Payer: Kaiser Permanente Medicare	$15.03
Rate for Payer: MDX Hawaii PPO	$34.71
Rate for Payer: Ohana Health Plan Medicaid	$15.03
Rate for Payer: Ohana Health Plan Medicare	$15.03
Rate for Payer: UnitedHealthcare Medicaid	$21.47
Rate for Payer: UnitedHealthcare Medicare	$15.03
Rate for Payer: University Health Alliance Commercial	$26.08

risperiDONE 2 mg Tab [KMC]

Facility

$30.40

Service Code	NDC 43547034206
Hospital Revenue Code	250
Min. Negotiated Rate	$25.84
Max. Negotiated Rate	$29.49
Rate for Payer: Cash Price	$19.76
Rate for Payer: Health Management Network Commercial	$25.84
Rate for Payer: Kaiser Permanente Commercial	$27.36
Rate for Payer: MDX Hawaii PPO	$29.49

risperiDONE 2 mg Tab [KMC]

Facility

$30.40

Service Code	NDC 43547034206
Hospital Revenue Code	250
Min. Negotiated Rate	$12.77
Max. Negotiated Rate	$29.49
Rate for Payer: AlohaCare Medicaid	$15.20
Rate for Payer: AlohaCare Medicare	$12.77
Rate for Payer: Cash Price	$19.76
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$27.97
Rate for Payer: Devoted Health Medicare	$12.77
Rate for Payer: Hawaii Medical Service Association Medicare	$12.77
Rate for Payer: Hawaii Western Management Group Commercial	$28.88
Rate for Payer: Health Management Network Commercial	$25.84
Rate for Payer: Humana Medicare	$12.77
Rate for Payer: Kaiser Permanente Commercial	$27.36
Rate for Payer: Kaiser Permanente Medicaid	$15.50
Rate for Payer: Kaiser Permanente Medicare	$12.77
Rate for Payer: MDX Hawaii PPO	$29.49
Rate for Payer: Ohana Health Plan Medicaid	$12.77
Rate for Payer: Ohana Health Plan Medicare	$12.77
Rate for Payer: UnitedHealthcare Medicaid	$18.24
Rate for Payer: UnitedHealthcare Medicare	$12.77
Rate for Payer: University Health Alliance Commercial	$22.16

risperiDONE 3 mg DIS Tab [KMC]

Facility

$45.16

Service Code	NDC 59746004022
Hospital Revenue Code	250
Min. Negotiated Rate	$38.39
Max. Negotiated Rate	$43.81
Rate for Payer: Cash Price	$29.35
Rate for Payer: Health Management Network Commercial	$38.39
Rate for Payer: Kaiser Permanente Commercial	$40.64
Rate for Payer: MDX Hawaii PPO	$43.81

risperiDONE 3 mg DIS Tab [KMC]

Facility

$45.16

Service Code	NDC 59746004022
Hospital Revenue Code	250
Min. Negotiated Rate	$18.97
Max. Negotiated Rate	$43.81
Rate for Payer: AlohaCare Medicaid	$22.58
Rate for Payer: AlohaCare Medicare	$18.97
Rate for Payer: Cash Price	$29.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$41.55
Rate for Payer: Devoted Health Medicare	$18.97
Rate for Payer: Hawaii Medical Service Association Medicare	$18.97
Rate for Payer: Hawaii Western Management Group Commercial	$42.90
Rate for Payer: Health Management Network Commercial	$38.39
Rate for Payer: Humana Medicare	$18.97
Rate for Payer: Kaiser Permanente Commercial	$40.64
Rate for Payer: Kaiser Permanente Medicaid	$23.03
Rate for Payer: Kaiser Permanente Medicare	$18.97
Rate for Payer: MDX Hawaii PPO	$43.81
Rate for Payer: Ohana Health Plan Medicaid	$18.97
Rate for Payer: Ohana Health Plan Medicare	$18.97
Rate for Payer: UnitedHealthcare Medicaid	$27.10
Rate for Payer: UnitedHealthcare Medicare	$18.97
Rate for Payer: University Health Alliance Commercial	$32.92

ritonavir 100 mg Tab [KMC]

Facility

$37.03

Service Code	NDC 65862068730
Hospital Revenue Code	250
Min. Negotiated Rate	$15.55
Max. Negotiated Rate	$35.92
Rate for Payer: AlohaCare Medicaid	$18.52
Rate for Payer: AlohaCare Medicare	$15.55
Rate for Payer: Cash Price	$24.07
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$34.07
Rate for Payer: Devoted Health Medicare	$15.55
Rate for Payer: Hawaii Medical Service Association Medicare	$15.55
Rate for Payer: Hawaii Western Management Group Commercial	$35.18
Rate for Payer: Health Management Network Commercial	$31.48
Rate for Payer: Humana Medicare	$15.55
Rate for Payer: Kaiser Permanente Commercial	$33.33
Rate for Payer: Kaiser Permanente Medicaid	$18.89
Rate for Payer: Kaiser Permanente Medicare	$15.55
Rate for Payer: MDX Hawaii PPO	$35.92
Rate for Payer: Ohana Health Plan Medicaid	$15.55
Rate for Payer: Ohana Health Plan Medicare	$15.55
Rate for Payer: UnitedHealthcare Medicaid	$22.22
Rate for Payer: UnitedHealthcare Medicare	$15.55
Rate for Payer: University Health Alliance Commercial	$26.99

ritonavir 100 mg Tab [KMC]

Facility

$37.03

Service Code	NDC 65862068730
Hospital Revenue Code	250
Min. Negotiated Rate	$31.48
Max. Negotiated Rate	$35.92
Rate for Payer: Cash Price	$24.07
Rate for Payer: Health Management Network Commercial	$31.48
Rate for Payer: Kaiser Permanente Commercial	$33.33
Rate for Payer: MDX Hawaii PPO	$35.92

Know your out-of-pocket cost for care.

All Charges