Kau Hospital

All Charges

Charge

Type

Setting

Price

RIGIFLEX 35/10 BLN M00554510

Facility

$1,854.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$1,575.90
Max. Negotiated Rate	$1,798.38
Rate for Payer: Cash Price	$1,112.40
Rate for Payer: Health Management Network Commercial	$1,575.90
Rate for Payer: Kaiser Permanente Commercial	$1,668.60
Rate for Payer: MDX Hawaii PPO	$1,798.38

RIM PLATE 12H 0.5MM 04.503.343

Facility

$2,229.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,248.24
Max. Negotiated Rate	$2,162.13
Rate for Payer: Cash Price	$1,337.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,560.30
Rate for Payer: Health Management Network Commercial	$1,894.65
Rate for Payer: Kaiser Permanente Commercial	$2,006.10
Rate for Payer: MDX Hawaii PPO	$2,162.13
Rate for Payer: University Health Alliance Commercial	$1,248.24

RIM PLATE 12H 0.5MM 04.503.343

Facility

$2,229.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$690.99
Max. Negotiated Rate	$2,162.13
Rate for Payer: AlohaCare Medicaid	$1,114.50
Rate for Payer: AlohaCare Medicare	$690.99
Rate for Payer: Cash Price	$1,337.40
Rate for Payer: Devoted Health Medicare	$757.86
Rate for Payer: Hawaii Medical Service Association Medicare	$690.99
Rate for Payer: Hawaii Western Management Group Commercial	$1,560.30
Rate for Payer: Health Management Network Commercial	$1,894.65
Rate for Payer: Humana Medicare	$690.99
Rate for Payer: Kaiser Permanente Commercial	$2,006.10
Rate for Payer: Kaiser Permanente Medicaid	$1,136.79
Rate for Payer: Kaiser Permanente Medicare	$690.99
Rate for Payer: MDX Hawaii PPO	$2,162.13
Rate for Payer: Ohana Health Plan Medicaid	$690.99
Rate for Payer: Ohana Health Plan Medicare	$690.99
Rate for Payer: UnitedHealthcare Medicare	$690.99
Rate for Payer: University Health Alliance Commercial	$1,248.24

RING FULL 220MM 99-56-20080

Facility

$3,506.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,980.10
Max. Negotiated Rate	$3,400.82
Rate for Payer: Cash Price	$2,103.60
Rate for Payer: Health Management Network Commercial	$2,980.10
Rate for Payer: Kaiser Permanente Commercial	$3,155.40
Rate for Payer: MDX Hawaii PPO	$3,400.82

RING FULL 220MM 99-56-20080

Facility

$3,506.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,086.86
Max. Negotiated Rate	$3,400.82
Rate for Payer: AlohaCare Medicaid	$1,753.00
Rate for Payer: AlohaCare Medicare	$1,086.86
Rate for Payer: Cash Price	$2,103.60
Rate for Payer: Devoted Health Medicare	$1,192.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,086.86
Rate for Payer: Hawaii Western Management Group Commercial	$3,330.70
Rate for Payer: Health Management Network Commercial	$2,980.10
Rate for Payer: Humana Medicare	$1,086.86
Rate for Payer: Kaiser Permanente Commercial	$3,155.40
Rate for Payer: Kaiser Permanente Medicaid	$1,788.06
Rate for Payer: Kaiser Permanente Medicare	$1,086.86
Rate for Payer: MDX Hawaii PPO	$3,400.82
Rate for Payer: Ohana Health Plan Medicaid	$1,086.86
Rate for Payer: Ohana Health Plan Medicare	$1,086.86
Rate for Payer: UnitedHealthcare Medicare	$1,086.86
Rate for Payer: University Health Alliance Commercial	$2,555.52

RING HALF 220MM 56-11670

Facility

$2,313.00

Hospital Revenue Code	272
Min. Negotiated Rate	$717.03
Max. Negotiated Rate	$2,243.61
Rate for Payer: AlohaCare Medicaid	$1,156.50
Rate for Payer: AlohaCare Medicare	$717.03
Rate for Payer: Cash Price	$1,387.80
Rate for Payer: Devoted Health Medicare	$786.42
Rate for Payer: Hawaii Medical Service Association Medicare	$717.03
Rate for Payer: Hawaii Western Management Group Commercial	$2,197.35
Rate for Payer: Health Management Network Commercial	$1,966.05
Rate for Payer: Humana Medicare	$717.03
Rate for Payer: Kaiser Permanente Commercial	$2,081.70
Rate for Payer: Kaiser Permanente Medicaid	$1,179.63
Rate for Payer: Kaiser Permanente Medicare	$717.03
Rate for Payer: MDX Hawaii PPO	$2,243.61
Rate for Payer: Ohana Health Plan Medicaid	$717.03
Rate for Payer: Ohana Health Plan Medicare	$717.03
Rate for Payer: UnitedHealthcare Medicare	$717.03
Rate for Payer: University Health Alliance Commercial	$1,685.95

RING HALF 220MM 56-11670

Facility

$2,313.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,966.05
Max. Negotiated Rate	$2,243.61
Rate for Payer: Cash Price	$1,387.80
Rate for Payer: Health Management Network Commercial	$1,966.05
Rate for Payer: Kaiser Permanente Commercial	$2,081.70
Rate for Payer: MDX Hawaii PPO	$2,243.61

RISPERIDONE 0.5 MG TABLET [25520]

Facility

$15.00

Service Code	NDC 68084027111
Hospital Revenue Code	637
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$4.65
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$5.10
Rate for Payer: Hawaii Medical Service Association Medicare	$4.65
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$4.65
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$4.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$4.65
Rate for Payer: Ohana Health Plan Medicare	$4.65
Rate for Payer: UnitedHealthcare Medicare	$4.65
Rate for Payer: University Health Alliance Commercial	$10.93

RISPERIDONE 0.5 MG TABLET [25520]

Facility

$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: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

RISPERIDONE 1 MG TABLET [18313]

Facility

$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: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

RISPERIDONE 1 MG TABLET [18313]

Facility

$16.00

Service Code	NDC 68084027201
Hospital Revenue Code	637
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$15.52
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$4.96
Rate for Payer: Cash Price	$9.60
Rate for Payer: Devoted Health Medicare	$5.44
Rate for Payer: Hawaii Medical Service Association Medicare	$4.96
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Humana Medicare	$4.96
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$4.96
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$4.96
Rate for Payer: Ohana Health Plan Medicare	$4.96
Rate for Payer: UnitedHealthcare Medicare	$4.96
Rate for Payer: University Health Alliance Commercial	$11.66

RISPERIDONE 1 MG TABLET [18313]

Facility

$16.00

Service Code	NDC 68084027211
Hospital Revenue Code	637
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$15.52
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$4.96
Rate for Payer: Cash Price	$9.60
Rate for Payer: Devoted Health Medicare	$5.44
Rate for Payer: Hawaii Medical Service Association Medicare	$4.96
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Humana Medicare	$4.96
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$4.96
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$4.96
Rate for Payer: Ohana Health Plan Medicare	$4.96
Rate for Payer: UnitedHealthcare Medicare	$4.96
Rate for Payer: University Health Alliance Commercial	$11.66

RISPERIDONE 1 MG TABLET [18313]

Facility

$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: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

RISPERIDONE 1 MG TABLET [18313]

Facility

$16.00

Service Code	NDC 68382011414
Hospital Revenue Code	637
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$15.52
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$4.96
Rate for Payer: Cash Price	$9.60
Rate for Payer: Devoted Health Medicare	$5.44
Rate for Payer: Hawaii Medical Service Association Medicare	$4.96
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Humana Medicare	$4.96
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$4.96
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$4.96
Rate for Payer: Ohana Health Plan Medicare	$4.96
Rate for Payer: UnitedHealthcare Medicare	$4.96
Rate for Payer: University Health Alliance Commercial	$11.66

RISPERIDONE 1 MG TABLET [18313]

Facility

$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: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

RISPERIDONE 2 MG TABLET [18311]

Facility

$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: Kaiser Permanente Commercial	$20.70
Rate for Payer: MDX Hawaii PPO	$22.31

RISPERIDONE 2 MG TABLET [18311]

Facility

$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: Kaiser Permanente Commercial	$20.70
Rate for Payer: MDX Hawaii PPO	$22.31

RISPERIDONE 2 MG TABLET [18311]

Facility

$23.00

Service Code	NDC 68084027301
Hospital Revenue Code	637
Min. Negotiated Rate	$7.13
Max. Negotiated Rate	$22.31
Rate for Payer: AlohaCare Medicaid	$11.50
Rate for Payer: AlohaCare Medicare	$7.13
Rate for Payer: Cash Price	$13.80
Rate for Payer: Devoted Health Medicare	$7.82
Rate for Payer: Hawaii Medical Service Association Medicare	$7.13
Rate for Payer: Hawaii Western Management Group Commercial	$21.85
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Humana Medicare	$7.13
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: Kaiser Permanente Medicare	$7.13
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: Ohana Health Plan Medicaid	$7.13
Rate for Payer: Ohana Health Plan Medicare	$7.13
Rate for Payer: UnitedHealthcare Medicare	$7.13
Rate for Payer: University Health Alliance Commercial	$16.76

RISPERIDONE 2 MG TABLET [18311]

Facility

$23.00

Service Code	NDC 68084027311
Hospital Revenue Code	637
Min. Negotiated Rate	$7.13
Max. Negotiated Rate	$22.31
Rate for Payer: AlohaCare Medicaid	$11.50
Rate for Payer: AlohaCare Medicare	$7.13
Rate for Payer: Cash Price	$13.80
Rate for Payer: Devoted Health Medicare	$7.82
Rate for Payer: Hawaii Medical Service Association Medicare	$7.13
Rate for Payer: Hawaii Western Management Group Commercial	$21.85
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Humana Medicare	$7.13
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: Kaiser Permanente Medicare	$7.13
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: Ohana Health Plan Medicaid	$7.13
Rate for Payer: Ohana Health Plan Medicare	$7.13
Rate for Payer: UnitedHealthcare Medicare	$7.13
Rate for Payer: University Health Alliance Commercial	$16.76

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

Facility

$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	$1,989.50
Rate for Payer: AlohaCare Medicare	$1,233.49
Rate for Payer: Cash Price	$2,387.40
Rate for Payer: Cash Price	$2,387.40
Rate for Payer: Devoted Health Medicare	$1,352.86
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	$1,233.49
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	$1,233.49
Rate for Payer: Kaiser Permanente Commercial	$3,581.10
Rate for Payer: Kaiser Permanente Medicaid	$2,029.29
Rate for Payer: Kaiser Permanente Medicare	$1,233.49
Rate for Payer: MDX Hawaii PPO	$3,859.63
Rate for Payer: Ohana Health Plan Medicaid	$1,233.49
Rate for Payer: Ohana Health Plan Medicare	$1,233.49
Rate for Payer: UnitedHealthcare Medicaid	$2,387.40
Rate for Payer: UnitedHealthcare Medicare	$1,233.49
Rate for Payer: University Health Alliance Commercial	$2,900.29

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

Facility

$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: Kaiser Permanente Commercial	$3,581.10
Rate for Payer: MDX Hawaii PPO	$3,859.63

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

Facility

$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: Kaiser Permanente Commercial	$2,798.10
Rate for Payer: MDX Hawaii PPO	$3,015.73

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

Facility

$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	$1,554.50
Rate for Payer: AlohaCare Medicare	$963.79
Rate for Payer: Cash Price	$1,865.40
Rate for Payer: Cash Price	$1,865.40
Rate for Payer: Devoted Health Medicare	$1,057.06
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	$963.79
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	$963.79
Rate for Payer: Kaiser Permanente Commercial	$2,798.10
Rate for Payer: Kaiser Permanente Medicaid	$1,585.59
Rate for Payer: Kaiser Permanente Medicare	$963.79
Rate for Payer: MDX Hawaii PPO	$3,015.73
Rate for Payer: Ohana Health Plan Medicaid	$963.79
Rate for Payer: Ohana Health Plan Medicare	$963.79
Rate for Payer: UnitedHealthcare Medicaid	$1,865.40
Rate for Payer: UnitedHealthcare Medicare	$963.79
Rate for Payer: University Health Alliance Commercial	$2,266.15

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

Facility

$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: Kaiser Permanente Commercial	$1,495.80
Rate for Payer: MDX Hawaii PPO	$1,612.14

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

Facility

$1,662.00

Service Code	HCPCS J2801
Hospital Revenue Code	636
Min. Negotiated Rate	$16.29
Max. Negotiated Rate	$1,612.14
Rate for Payer: AlohaCare Medicaid	$831.00
Rate for Payer: AlohaCare Medicare	$515.22
Rate for Payer: Cash Price	$997.20
Rate for Payer: Cash Price	$997.20
Rate for Payer: Devoted Health Medicare	$565.08
Rate for Payer: Hawaii Medical Service Association Commercial	$16.29
Rate for Payer: Hawaii Medical Service Association Medicare	$515.22
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	$515.22
Rate for Payer: Kaiser Permanente Commercial	$1,495.80
Rate for Payer: Kaiser Permanente Medicaid	$847.62
Rate for Payer: Kaiser Permanente Medicare	$515.22
Rate for Payer: MDX Hawaii PPO	$1,612.14
Rate for Payer: Ohana Health Plan Medicaid	$515.22
Rate for Payer: Ohana Health Plan Medicare	$515.22
Rate for Payer: UnitedHealthcare Medicaid	$997.20
Rate for Payer: UnitedHealthcare Medicare	$515.22
Rate for Payer: University Health Alliance Commercial	$1,211.43

Know your out-of-pocket cost for care.

All Charges