Kona Community Hospital

All Charges

Charge

Type

Setting

Price

RISPERIDONE 0.5 MG PO RAPID DISSOLVING TAB

Facility

$27.14

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$13.84
Max. Negotiated Rate	$26.33
Rate for Payer: Cash Price	$17.64
Rate for Payer: Hawaii Western Management Group Commercial	$25.78
Rate for Payer: Health Management Network Commercial	$23.07
Rate for Payer: Kaiser Permanente Commercial	$17.10
Rate for Payer: Kaiser Permanente Medicaid	$13.84
Rate for Payer: MDX Hawaii PPO	$26.33
Rate for Payer: UnitedHealthcare Medicaid	$16.28
Rate for Payer: University Health Alliance Commercial	$19.78

RISPERIDONE 1 MG PO RAPID DISSOLVING TAB

Facility

$30.38

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$29.47
Rate for Payer: Cash Price	$19.75
Rate for Payer: Hawaii Western Management Group Commercial	$28.86
Rate for Payer: Health Management Network Commercial	$25.82
Rate for Payer: Kaiser Permanente Commercial	$19.14
Rate for Payer: Kaiser Permanente Medicaid	$15.49
Rate for Payer: MDX Hawaii PPO	$29.47
Rate for Payer: UnitedHealthcare Medicaid	$18.23
Rate for Payer: University Health Alliance Commercial	$22.14

RISPERIDONE 1 MG PO RAPID DISSOLVING TAB

Facility

$30.38

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$25.82
Max. Negotiated Rate	$29.47
Rate for Payer: Cash Price	$19.75
Rate for Payer: Health Management Network Commercial	$25.82
Rate for Payer: MDX Hawaii PPO	$29.47

RISPERIDONE 1 MG PO TABLET

Facility

$25.07

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.79
Max. Negotiated Rate	$24.32
Rate for Payer: Cash Price	$16.30
Rate for Payer: Hawaii Western Management Group Commercial	$23.82
Rate for Payer: Health Management Network Commercial	$21.31
Rate for Payer: Kaiser Permanente Commercial	$15.79
Rate for Payer: Kaiser Permanente Medicaid	$12.79
Rate for Payer: MDX Hawaii PPO	$24.32
Rate for Payer: UnitedHealthcare Medicaid	$15.04
Rate for Payer: University Health Alliance Commercial	$18.27

RISPERIDONE 1 MG PO TABLET

Facility

$25.07

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$21.31
Max. Negotiated Rate	$24.32
Rate for Payer: Cash Price	$16.30
Rate for Payer: Health Management Network Commercial	$21.31
Rate for Payer: MDX Hawaii PPO	$24.32

RISPERIDONE 2 MG PO TABLET

Facility

$46.31

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$39.36
Max. Negotiated Rate	$44.92
Rate for Payer: Cash Price	$30.10
Rate for Payer: Health Management Network Commercial	$39.36
Rate for Payer: MDX Hawaii PPO	$44.92

RISPERIDONE 2 MG PO TABLET

Facility

$46.31

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$44.92
Rate for Payer: Cash Price	$30.10
Rate for Payer: Hawaii Western Management Group Commercial	$43.99
Rate for Payer: Health Management Network Commercial	$39.36
Rate for Payer: Kaiser Permanente Commercial	$29.18
Rate for Payer: Kaiser Permanente Medicaid	$23.62
Rate for Payer: MDX Hawaii PPO	$44.92
Rate for Payer: UnitedHealthcare Medicaid	$27.79
Rate for Payer: University Health Alliance Commercial	$33.76

RISPERIDONE 4 MG PO TABLET

Facility

$67.57

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$34.46
Max. Negotiated Rate	$65.54
Rate for Payer: Cash Price	$43.92
Rate for Payer: Hawaii Western Management Group Commercial	$64.19
Rate for Payer: Health Management Network Commercial	$57.43
Rate for Payer: Kaiser Permanente Commercial	$42.57
Rate for Payer: Kaiser Permanente Medicaid	$34.46
Rate for Payer: MDX Hawaii PPO	$65.54
Rate for Payer: UnitedHealthcare Medicaid	$40.54
Rate for Payer: University Health Alliance Commercial	$49.25

RISPERIDONE 4 MG PO TABLET

Facility

$67.57

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$57.43
Max. Negotiated Rate	$65.54
Rate for Payer: Cash Price	$43.92
Rate for Payer: Health Management Network Commercial	$57.43
Rate for Payer: MDX Hawaii PPO	$65.54

RISPERIDONE MICROSPHERES 12.5 MG/2 ML IM SSRR

Facility

$909.89

Service Code	HCPCS J2794
Hospital Revenue Code	636
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$882.59
Rate for Payer: AlohaCare Medicaid	$10.80
Rate for Payer: AlohaCare Medicare	$10.80
Rate for Payer: Cash Price	$591.43
Rate for Payer: Cash Price	$591.43
Rate for Payer: Devoted Health Medicare	$11.88
Rate for Payer: Hawaii Medical Service Association ABD	$10.94
Rate for Payer: Hawaii Medical Service Association Commercial	$13.50
Rate for Payer: Hawaii Medical Service Association Medicare	$10.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.94
Rate for Payer: Hawaii Western Management Group Commercial	$864.40
Rate for Payer: Health Management Network Commercial	$773.41
Rate for Payer: Humana Medicare	$10.80
Rate for Payer: Kaiser Permanente Commercial	$573.23
Rate for Payer: Kaiser Permanente Medicaid	$464.04
Rate for Payer: Kaiser Permanente Medicare	$10.80
Rate for Payer: MDX Hawaii PPO	$882.59
Rate for Payer: Ohana Health Plan Medicaid	$11.88
Rate for Payer: Ohana Health Plan Medicare	$10.80
Rate for Payer: UnitedHealthcare Medicaid	$545.93
Rate for Payer: UnitedHealthcare Medicare	$10.80
Rate for Payer: University Health Alliance Commercial	$663.22

RISPERIDONE MICROSPHERES 12.5 MG/2 ML IM SSRR

Facility

$909.89

Service Code	HCPCS J2794
Hospital Revenue Code	250
Min. Negotiated Rate	$773.41
Max. Negotiated Rate	$882.59
Rate for Payer: Cash Price	$591.43
Rate for Payer: Health Management Network Commercial	$773.41
Rate for Payer: MDX Hawaii PPO	$882.59

RISPERIDONE MICROSPHERES 25 MG/2 ML IM SSRR

Facility

$1,579.63

Service Code	HCPCS J2794
Hospital Revenue Code	636
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$1,532.24
Rate for Payer: AlohaCare Medicaid	$10.80
Rate for Payer: AlohaCare Medicare	$10.80
Rate for Payer: Cash Price	$1,026.76
Rate for Payer: Cash Price	$1,026.76
Rate for Payer: Devoted Health Medicare	$11.88
Rate for Payer: Hawaii Medical Service Association ABD	$10.94
Rate for Payer: Hawaii Medical Service Association Commercial	$13.50
Rate for Payer: Hawaii Medical Service Association Medicare	$10.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.94
Rate for Payer: Hawaii Western Management Group Commercial	$1,500.65
Rate for Payer: Health Management Network Commercial	$1,342.69
Rate for Payer: Humana Medicare	$10.80
Rate for Payer: Kaiser Permanente Commercial	$995.17
Rate for Payer: Kaiser Permanente Medicaid	$805.61
Rate for Payer: Kaiser Permanente Medicare	$10.80
Rate for Payer: MDX Hawaii PPO	$1,532.24
Rate for Payer: Ohana Health Plan Medicaid	$11.88
Rate for Payer: Ohana Health Plan Medicare	$10.80
Rate for Payer: UnitedHealthcare Medicaid	$947.78
Rate for Payer: UnitedHealthcare Medicare	$10.80
Rate for Payer: University Health Alliance Commercial	$1,151.39

RISPERIDONE MICROSPHERES 25 MG/2 ML IM SSRR

Facility

$1,579.63

Service Code	HCPCS J2794
Hospital Revenue Code	250
Min. Negotiated Rate	$1,342.69
Max. Negotiated Rate	$1,532.24
Rate for Payer: Cash Price	$1,026.76
Rate for Payer: Health Management Network Commercial	$1,342.69
Rate for Payer: MDX Hawaii PPO	$1,532.24

RITONAVIR 100 MG PO TABLET

Facility

$64.58

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$32.94
Max. Negotiated Rate	$62.64
Rate for Payer: Cash Price	$41.98
Rate for Payer: Cash Price	$35.35
Rate for Payer: Hawaii Western Management Group Commercial	$51.66
Rate for Payer: Hawaii Western Management Group Commercial	$61.35
Rate for Payer: Health Management Network Commercial	$46.22
Rate for Payer: Health Management Network Commercial	$54.89
Rate for Payer: Kaiser Permanente Commercial	$34.26
Rate for Payer: Kaiser Permanente Commercial	$40.69
Rate for Payer: Kaiser Permanente Medicaid	$32.94
Rate for Payer: Kaiser Permanente Medicaid	$27.73
Rate for Payer: MDX Hawaii PPO	$52.75
Rate for Payer: MDX Hawaii PPO	$62.64
Rate for Payer: UnitedHealthcare Medicaid	$32.63
Rate for Payer: UnitedHealthcare Medicaid	$38.75
Rate for Payer: University Health Alliance Commercial	$39.64
Rate for Payer: University Health Alliance Commercial	$47.07

RITONAVIR 100 MG PO TABLET

Facility

$54.38

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$46.22
Max. Negotiated Rate	$52.75
Rate for Payer: Cash Price	$35.35
Rate for Payer: Cash Price	$41.98
Rate for Payer: Health Management Network Commercial	$46.22
Rate for Payer: Health Management Network Commercial	$54.89
Rate for Payer: MDX Hawaii PPO	$52.75
Rate for Payer: MDX Hawaii PPO	$62.64

RITUXIMAB 10 MG/ML IV CONC

Facility

$2,190.45

Service Code	HCPCS J9312
Hospital Revenue Code	636
Min. Negotiated Rate	$74.16
Max. Negotiated Rate	$2,124.74
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	$1,423.79
Rate for Payer: Cash Price	$4,391.09
Rate for Payer: Cash Price	$4,391.09
Rate for Payer: Cash Price	$1,423.79
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	$6,417.74
Rate for Payer: Hawaii Western Management Group Commercial	$2,080.93
Rate for Payer: Health Management Network Commercial	$5,742.19
Rate for Payer: Health Management Network Commercial	$1,861.88
Rate for Payer: Humana Medicare	$74.16
Rate for Payer: Humana Medicare	$74.16
Rate for Payer: Kaiser Permanente Commercial	$4,255.98
Rate for Payer: Kaiser Permanente Commercial	$1,379.98
Rate for Payer: Kaiser Permanente Medicaid	$3,445.32
Rate for Payer: Kaiser Permanente Medicaid	$1,117.13
Rate for Payer: Kaiser Permanente Medicare	$74.16
Rate for Payer: Kaiser Permanente Medicare	$74.16
Rate for Payer: MDX Hawaii PPO	$6,552.85
Rate for Payer: MDX Hawaii PPO	$2,124.74
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	$1,314.27
Rate for Payer: UnitedHealthcare Medicaid	$4,053.31
Rate for Payer: UnitedHealthcare Medicare	$74.16
Rate for Payer: UnitedHealthcare Medicare	$74.16
Rate for Payer: University Health Alliance Commercial	$1,596.62
Rate for Payer: University Health Alliance Commercial	$4,924.10

RITUXIMAB 10 MG/ML IV CONC

Facility

$2,190.45

Service Code	HCPCS J9312
Hospital Revenue Code	250
Min. Negotiated Rate	$1,861.88
Max. Negotiated Rate	$2,124.74
Rate for Payer: Cash Price	$1,423.79
Rate for Payer: Cash Price	$4,391.09
Rate for Payer: Health Management Network Commercial	$5,742.19
Rate for Payer: Health Management Network Commercial	$1,861.88
Rate for Payer: MDX Hawaii PPO	$2,124.74
Rate for Payer: MDX Hawaii PPO	$6,552.85

RITUXIMAB-ABBS 10 MG/ML IV SOLN

Facility

$7,206.36

Service Code	HCPCS Q5115
Hospital Revenue Code	250
Min. Negotiated Rate	$31.18
Max. Negotiated Rate	$6,990.17
Rate for Payer: AlohaCare Medicaid	$31.28
Rate for Payer: AlohaCare Medicaid	$31.28
Rate for Payer: AlohaCare Medicare	$31.28
Rate for Payer: AlohaCare Medicare	$31.28
Rate for Payer: Cash Price	$4,684.13
Rate for Payer: Cash Price	$4,684.13
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Devoted Health Medicare	$34.41
Rate for Payer: Devoted Health Medicare	$34.41
Rate for Payer: Hawaii Medical Service Association ABD	$31.18
Rate for Payer: Hawaii Medical Service Association ABD	$31.18
Rate for Payer: Hawaii Medical Service Association Commercial	$39.10
Rate for Payer: Hawaii Medical Service Association Commercial	$39.10
Rate for Payer: Hawaii Medical Service Association Medicare	$31.28
Rate for Payer: Hawaii Medical Service Association Medicare	$31.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$31.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$31.18
Rate for Payer: Hawaii Western Management Group Commercial	$2,219.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,846.04
Rate for Payer: Health Management Network Commercial	$1,985.60
Rate for Payer: Health Management Network Commercial	$6,125.41
Rate for Payer: Humana Medicare	$31.28
Rate for Payer: Humana Medicare	$31.28
Rate for Payer: Kaiser Permanente Commercial	$1,471.68
Rate for Payer: Kaiser Permanente Commercial	$4,540.01
Rate for Payer: Kaiser Permanente Medicaid	$3,675.24
Rate for Payer: Kaiser Permanente Medicaid	$1,191.36
Rate for Payer: Kaiser Permanente Medicare	$31.28
Rate for Payer: Kaiser Permanente Medicare	$31.28
Rate for Payer: MDX Hawaii PPO	$6,990.17
Rate for Payer: MDX Hawaii PPO	$2,265.92
Rate for Payer: Ohana Health Plan Medicaid	$34.41
Rate for Payer: Ohana Health Plan Medicaid	$34.41
Rate for Payer: Ohana Health Plan Medicare	$31.28
Rate for Payer: Ohana Health Plan Medicare	$31.28
Rate for Payer: UnitedHealthcare Medicaid	$4,323.82
Rate for Payer: UnitedHealthcare Medicaid	$1,401.60
Rate for Payer: UnitedHealthcare Medicare	$31.28
Rate for Payer: UnitedHealthcare Medicare	$31.28
Rate for Payer: University Health Alliance Commercial	$5,252.72
Rate for Payer: University Health Alliance Commercial	$1,702.71

RITUXIMAB-ABBS 10 MG/ML IV SOLN

Facility

$2,336.00

Service Code	HCPCS Q5115
Hospital Revenue Code	250
Min. Negotiated Rate	$1,985.60
Max. Negotiated Rate	$2,265.92
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Cash Price	$4,684.13
Rate for Payer: Health Management Network Commercial	$1,985.60
Rate for Payer: Health Management Network Commercial	$6,125.41
Rate for Payer: MDX Hawaii PPO	$2,265.92
Rate for Payer: MDX Hawaii PPO	$6,990.17

RITUXIMAB-PVVR 10 MG/ML IV SOLN

Facility

$5,419.20

Service Code	HCPCS Q5119
Hospital Revenue Code	250
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$5,256.62
Rate for Payer: AlohaCare Medicaid	$13.69
Rate for Payer: AlohaCare Medicaid	$13.69
Rate for Payer: AlohaCare Medicare	$13.69
Rate for Payer: AlohaCare Medicare	$13.69
Rate for Payer: Cash Price	$3,522.48
Rate for Payer: Cash Price	$3,522.48
Rate for Payer: Cash Price	$1,123.25
Rate for Payer: Cash Price	$1,123.25
Rate for Payer: Devoted Health Medicare	$15.06
Rate for Payer: Devoted Health Medicare	$15.06
Rate for Payer: Hawaii Medical Service Association ABD	$26.50
Rate for Payer: Hawaii Medical Service Association ABD	$26.50
Rate for Payer: Hawaii Medical Service Association Commercial	$17.11
Rate for Payer: Hawaii Medical Service Association Commercial	$17.11
Rate for Payer: Hawaii Medical Service Association Medicare	$13.69
Rate for Payer: Hawaii Medical Service Association Medicare	$13.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,641.68
Rate for Payer: Hawaii Western Management Group Commercial	$5,148.24
Rate for Payer: Health Management Network Commercial	$1,468.87
Rate for Payer: Health Management Network Commercial	$4,606.32
Rate for Payer: Humana Medicare	$13.69
Rate for Payer: Humana Medicare	$13.69
Rate for Payer: Kaiser Permanente Commercial	$1,088.69
Rate for Payer: Kaiser Permanente Commercial	$3,414.10
Rate for Payer: Kaiser Permanente Medicaid	$2,763.79
Rate for Payer: Kaiser Permanente Medicaid	$881.32
Rate for Payer: Kaiser Permanente Medicare	$13.69
Rate for Payer: Kaiser Permanente Medicare	$13.69
Rate for Payer: MDX Hawaii PPO	$5,256.62
Rate for Payer: MDX Hawaii PPO	$1,676.24
Rate for Payer: Ohana Health Plan Medicaid	$15.06
Rate for Payer: Ohana Health Plan Medicaid	$15.06
Rate for Payer: Ohana Health Plan Medicare	$13.69
Rate for Payer: Ohana Health Plan Medicare	$13.69
Rate for Payer: UnitedHealthcare Medicaid	$3,251.52
Rate for Payer: UnitedHealthcare Medicaid	$1,036.85
Rate for Payer: UnitedHealthcare Medicare	$13.69
Rate for Payer: UnitedHealthcare Medicare	$13.69
Rate for Payer: University Health Alliance Commercial	$3,950.05
Rate for Payer: University Health Alliance Commercial	$1,259.60

RITUXIMAB-PVVR 10 MG/ML IV SOLN

Facility

$1,728.08

Service Code	HCPCS Q5119
Hospital Revenue Code	250
Min. Negotiated Rate	$1,468.87
Max. Negotiated Rate	$1,676.24
Rate for Payer: Cash Price	$1,123.25
Rate for Payer: Cash Price	$3,522.48
Rate for Payer: Health Management Network Commercial	$1,468.87
Rate for Payer: Health Management Network Commercial	$4,606.32
Rate for Payer: MDX Hawaii PPO	$1,676.24
Rate for Payer: MDX Hawaii PPO	$5,256.62

RIVAROXABAN 10 MG PO TABLET

Facility

$100.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$51.28
Max. Negotiated Rate	$97.52
Rate for Payer: Cash Price	$65.35
Rate for Payer: Hawaii Western Management Group Commercial	$95.51
Rate for Payer: Health Management Network Commercial	$85.46
Rate for Payer: Kaiser Permanente Commercial	$63.34
Rate for Payer: Kaiser Permanente Medicaid	$51.28
Rate for Payer: MDX Hawaii PPO	$97.52
Rate for Payer: UnitedHealthcare Medicaid	$60.32
Rate for Payer: University Health Alliance Commercial	$73.28

RIVAROXABAN 10 MG PO TABLET

Facility

$100.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$85.46
Max. Negotiated Rate	$97.52
Rate for Payer: Cash Price	$65.35
Rate for Payer: Health Management Network Commercial	$85.46
Rate for Payer: MDX Hawaii PPO	$97.52

RIVAROXABAN 15 MG PO TABLET

Facility

$100.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$51.28
Max. Negotiated Rate	$97.52
Rate for Payer: Cash Price	$65.35
Rate for Payer: Hawaii Western Management Group Commercial	$95.51
Rate for Payer: Health Management Network Commercial	$85.46
Rate for Payer: Kaiser Permanente Commercial	$63.34
Rate for Payer: Kaiser Permanente Medicaid	$51.28
Rate for Payer: MDX Hawaii PPO	$97.52
Rate for Payer: UnitedHealthcare Medicaid	$60.32
Rate for Payer: University Health Alliance Commercial	$73.28

RIVAROXABAN 15 MG PO TABLET

Facility

$100.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$85.46
Max. Negotiated Rate	$97.52
Rate for Payer: Cash Price	$65.35
Rate for Payer: Health Management Network Commercial	$85.46
Rate for Payer: MDX Hawaii PPO	$97.52

Know your out-of-pocket cost for care.

All Charges