Kona Community Hospital

All Charges

Charge

Type

Setting

Price

RIVAROXABAN 20 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 20 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

RIVASTIGMINE TARTRATE 1.5 MG PO CAP

Facility

$25.74

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$24.97
Rate for Payer: Cash Price	$16.73
Rate for Payer: Cash Price	$14.47
Rate for Payer: Hawaii Western Management Group Commercial	$21.15
Rate for Payer: Hawaii Western Management Group Commercial	$24.45
Rate for Payer: Health Management Network Commercial	$18.92
Rate for Payer: Health Management Network Commercial	$21.88
Rate for Payer: Kaiser Permanente Commercial	$16.22
Rate for Payer: Kaiser Permanente Commercial	$14.02
Rate for Payer: Kaiser Permanente Medicaid	$13.13
Rate for Payer: Kaiser Permanente Medicaid	$11.35
Rate for Payer: MDX Hawaii PPO	$21.59
Rate for Payer: MDX Hawaii PPO	$24.97
Rate for Payer: UnitedHealthcare Medicaid	$13.36
Rate for Payer: UnitedHealthcare Medicaid	$15.44
Rate for Payer: University Health Alliance Commercial	$18.76
Rate for Payer: University Health Alliance Commercial	$16.23

RIVASTIGMINE TARTRATE 1.5 MG PO CAP

Facility

$22.26

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$18.92
Max. Negotiated Rate	$21.59
Rate for Payer: Cash Price	$14.47
Rate for Payer: Cash Price	$16.73
Rate for Payer: Health Management Network Commercial	$18.92
Rate for Payer: Health Management Network Commercial	$21.88
Rate for Payer: MDX Hawaii PPO	$21.59
Rate for Payer: MDX Hawaii PPO	$24.97

RIVASTIGMINE TARTRATE 3 MG PO CAP

Facility

$22.26

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$18.92
Max. Negotiated Rate	$21.59
Rate for Payer: Cash Price	$14.47
Rate for Payer: Cash Price	$16.73
Rate for Payer: Health Management Network Commercial	$21.88
Rate for Payer: Health Management Network Commercial	$18.92
Rate for Payer: MDX Hawaii PPO	$21.59
Rate for Payer: MDX Hawaii PPO	$24.97

RIVASTIGMINE TARTRATE 3 MG PO CAP

Facility

$22.26

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$21.59
Rate for Payer: Cash Price	$14.47
Rate for Payer: Cash Price	$16.73
Rate for Payer: Hawaii Western Management Group Commercial	$21.15
Rate for Payer: Hawaii Western Management Group Commercial	$24.45
Rate for Payer: Health Management Network Commercial	$18.92
Rate for Payer: Health Management Network Commercial	$21.88
Rate for Payer: Kaiser Permanente Commercial	$14.02
Rate for Payer: Kaiser Permanente Commercial	$16.22
Rate for Payer: Kaiser Permanente Medicaid	$11.35
Rate for Payer: Kaiser Permanente Medicaid	$13.13
Rate for Payer: MDX Hawaii PPO	$21.59
Rate for Payer: MDX Hawaii PPO	$24.97
Rate for Payer: UnitedHealthcare Medicaid	$15.44
Rate for Payer: UnitedHealthcare Medicaid	$13.36
Rate for Payer: University Health Alliance Commercial	$16.23
Rate for Payer: University Health Alliance Commercial	$18.76

Roadrunner Nimble Hydrophilic Guidewire G09607 [3642781]

Facility

$302.25

Service Code	HCPCS C1769
Hospital Charge Code	3642781
Hospital Revenue Code	272
Min. Negotiated Rate	$154.15
Max. Negotiated Rate	$293.18
Rate for Payer: Cash Price	$196.46
Rate for Payer: Hawaii Western Management Group Commercial	$287.14
Rate for Payer: Health Management Network Commercial	$256.91
Rate for Payer: Kaiser Permanente Commercial	$190.42
Rate for Payer: Kaiser Permanente Medicaid	$154.15
Rate for Payer: MDX Hawaii PPO	$293.18
Rate for Payer: University Health Alliance Commercial	$220.31

Roadrunner Nimble Hydrophilic Guidewire G09607 [3642781]

Facility

$302.25

Service Code	HCPCS C1769
Hospital Charge Code	3642781
Hospital Revenue Code	272
Min. Negotiated Rate	$256.91
Max. Negotiated Rate	$293.18
Rate for Payer: Cash Price	$196.46
Rate for Payer: Health Management Network Commercial	$256.91
Rate for Payer: MDX Hawaii PPO	$293.18

ROCURONIUM 10 MG/ML IV SOLN

Facility

$20.51

Service Code	NDC 00409318905
Hospital Revenue Code	250
Min. Negotiated Rate	$17.43
Max. Negotiated Rate	$19.89
Rate for Payer: Cash Price	$13.33
Rate for Payer: Health Management Network Commercial	$17.43
Rate for Payer: MDX Hawaii PPO	$19.89

ROCURONIUM 10 MG/ML IV SOLN

Facility

$60.38

Service Code	NDC 55150022505
Hospital Revenue Code	250
Min. Negotiated Rate	$30.79
Max. Negotiated Rate	$58.57
Rate for Payer: Cash Price	$39.25
Rate for Payer: Hawaii Western Management Group Commercial	$57.36
Rate for Payer: Health Management Network Commercial	$51.32
Rate for Payer: Kaiser Permanente Commercial	$38.04
Rate for Payer: Kaiser Permanente Medicaid	$30.79
Rate for Payer: MDX Hawaii PPO	$58.57
Rate for Payer: UnitedHealthcare Medicaid	$36.23
Rate for Payer: University Health Alliance Commercial	$44.01

ROCURONIUM 10 MG/ML IV SOLN

Facility

$20.51

Service Code	NDC 00409318905
Hospital Revenue Code	250
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$19.89
Rate for Payer: Cash Price	$13.33
Rate for Payer: Hawaii Western Management Group Commercial	$19.48
Rate for Payer: Health Management Network Commercial	$17.43
Rate for Payer: Kaiser Permanente Commercial	$12.92
Rate for Payer: Kaiser Permanente Medicaid	$10.46
Rate for Payer: MDX Hawaii PPO	$19.89
Rate for Payer: UnitedHealthcare Medicaid	$12.31
Rate for Payer: University Health Alliance Commercial	$14.95

ROCURONIUM 10 MG/ML IV SOLN

Facility

$16.56

Service Code	NDC 00143925001
Hospital Revenue Code	250
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: MDX Hawaii PPO	$16.06

ROCURONIUM 10 MG/ML IV SOLN

Facility

$16.56

Service Code	NDC 00143925001
Hospital Revenue Code	250
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Hawaii Western Management Group Commercial	$15.73
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: Kaiser Permanente Commercial	$10.43
Rate for Payer: Kaiser Permanente Medicaid	$8.45
Rate for Payer: MDX Hawaii PPO	$16.06
Rate for Payer: UnitedHealthcare Medicaid	$9.94
Rate for Payer: University Health Alliance Commercial	$12.07

ROCURONIUM 10 MG/ML IV SOLN

Facility

$16.56

Service Code	NDC 00143925010
Hospital Revenue Code	250
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: MDX Hawaii PPO	$16.06

ROCURONIUM 10 MG/ML IV SOLN

Facility

$20.51

Service Code	NDC 00409318910
Hospital Revenue Code	250
Min. Negotiated Rate	$17.43
Max. Negotiated Rate	$19.89
Rate for Payer: Cash Price	$13.33
Rate for Payer: Health Management Network Commercial	$17.43
Rate for Payer: MDX Hawaii PPO	$19.89

ROCURONIUM 10 MG/ML IV SOLN

Facility

$20.51

Service Code	NDC 00409318910
Hospital Revenue Code	250
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$19.89
Rate for Payer: Cash Price	$13.33
Rate for Payer: Hawaii Western Management Group Commercial	$19.48
Rate for Payer: Health Management Network Commercial	$17.43
Rate for Payer: Kaiser Permanente Commercial	$12.92
Rate for Payer: Kaiser Permanente Medicaid	$10.46
Rate for Payer: MDX Hawaii PPO	$19.89
Rate for Payer: UnitedHealthcare Medicaid	$12.31
Rate for Payer: University Health Alliance Commercial	$14.95

ROCURONIUM 10 MG/ML IV SOLN

Facility

$16.56

Service Code	NDC 00143925010
Hospital Revenue Code	250
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Hawaii Western Management Group Commercial	$15.73
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: Kaiser Permanente Commercial	$10.43
Rate for Payer: Kaiser Permanente Medicaid	$8.45
Rate for Payer: MDX Hawaii PPO	$16.06
Rate for Payer: UnitedHealthcare Medicaid	$9.94
Rate for Payer: University Health Alliance Commercial	$12.07

ROCURONIUM 10 MG/ML IV SOLN

Facility

$60.38

Service Code	NDC 55150022505
Hospital Revenue Code	250
Min. Negotiated Rate	$51.32
Max. Negotiated Rate	$58.57
Rate for Payer: Cash Price	$39.25
Rate for Payer: Health Management Network Commercial	$51.32
Rate for Payer: MDX Hawaii PPO	$58.57

ROMIPLOSTIM 125 MCG SUBCUTANEOUS RECON.SOLN.

Facility

$2,770.24

Service Code	HCPCS J2802
Hospital Revenue Code	250
Min. Negotiated Rate	$2,354.70
Max. Negotiated Rate	$2,687.13
Rate for Payer: Cash Price	$1,800.66
Rate for Payer: Health Management Network Commercial	$2,354.70
Rate for Payer: MDX Hawaii PPO	$2,687.13

ROMIPLOSTIM 125 MCG SUBCUTANEOUS RECON.SOLN.

Facility

$2,770.24

Service Code	HCPCS J2802
Hospital Revenue Code	636
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$2,687.13
Rate for Payer: AlohaCare Medicaid	$11.11
Rate for Payer: AlohaCare Medicare	$11.11
Rate for Payer: Cash Price	$1,800.66
Rate for Payer: Cash Price	$1,800.66
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	$2,631.73
Rate for Payer: Health Management Network Commercial	$2,354.70
Rate for Payer: Humana Medicare	$11.11
Rate for Payer: Kaiser Permanente Commercial	$1,745.25
Rate for Payer: Kaiser Permanente Medicaid	$1,412.82
Rate for Payer: Kaiser Permanente Medicare	$11.11
Rate for Payer: MDX Hawaii PPO	$2,687.13
Rate for Payer: Ohana Health Plan Medicaid	$12.22
Rate for Payer: Ohana Health Plan Medicare	$11.11
Rate for Payer: UnitedHealthcare Medicaid	$1,662.14
Rate for Payer: UnitedHealthcare Medicare	$11.11
Rate for Payer: University Health Alliance Commercial	$2,019.23

ROMIPLOSTIM 250 MCG SUBCUTANEOUS RECON.SOLN.

Facility

$4,422.03

Service Code	HCPCS J2802
Hospital Revenue Code	250
Min. Negotiated Rate	$3,758.73
Max. Negotiated Rate	$4,289.37
Rate for Payer: Cash Price	$2,874.32
Rate for Payer: Health Management Network Commercial	$3,758.73
Rate for Payer: MDX Hawaii PPO	$4,289.37

ROMIPLOSTIM 250 MCG SUBCUTANEOUS RECON.SOLN.

Facility

$4,422.03

Service Code	HCPCS J2802
Hospital Revenue Code	636
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$4,289.37
Rate for Payer: AlohaCare Medicaid	$11.11
Rate for Payer: AlohaCare Medicare	$11.11
Rate for Payer: Cash Price	$2,874.32
Rate for Payer: Cash Price	$2,874.32
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	$4,200.93
Rate for Payer: Health Management Network Commercial	$3,758.73
Rate for Payer: Humana Medicare	$11.11
Rate for Payer: Kaiser Permanente Commercial	$2,785.88
Rate for Payer: Kaiser Permanente Medicaid	$2,255.24
Rate for Payer: Kaiser Permanente Medicare	$11.11
Rate for Payer: MDX Hawaii PPO	$4,289.37
Rate for Payer: Ohana Health Plan Medicaid	$12.22
Rate for Payer: Ohana Health Plan Medicare	$11.11
Rate for Payer: UnitedHealthcare Medicaid	$2,653.22
Rate for Payer: UnitedHealthcare Medicare	$11.11
Rate for Payer: University Health Alliance Commercial	$3,223.22

ROMIPLOSTIM 500 MCG SUBCUTANEOUS RECON.SOLN.

Facility

$7,725.63

Service Code	HCPCS J2802
Hospital Revenue Code	636
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$7,493.86
Rate for Payer: AlohaCare Medicaid	$11.11
Rate for Payer: AlohaCare Medicare	$11.11
Rate for Payer: Cash Price	$5,021.66
Rate for Payer: Cash Price	$5,021.66
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	$7,339.35
Rate for Payer: Health Management Network Commercial	$6,566.79
Rate for Payer: Humana Medicare	$11.11
Rate for Payer: Kaiser Permanente Commercial	$4,867.15
Rate for Payer: Kaiser Permanente Medicaid	$3,940.07
Rate for Payer: Kaiser Permanente Medicare	$11.11
Rate for Payer: MDX Hawaii PPO	$7,493.86
Rate for Payer: Ohana Health Plan Medicaid	$12.22
Rate for Payer: Ohana Health Plan Medicare	$11.11
Rate for Payer: UnitedHealthcare Medicaid	$4,635.38
Rate for Payer: UnitedHealthcare Medicare	$11.11
Rate for Payer: University Health Alliance Commercial	$5,631.21

ROMIPLOSTIM 500 MCG SUBCUTANEOUS RECON.SOLN.

Facility

$7,725.63

Service Code	HCPCS J2802
Hospital Revenue Code	250
Min. Negotiated Rate	$6,566.79
Max. Negotiated Rate	$7,493.86
Rate for Payer: Cash Price	$5,021.66
Rate for Payer: Health Management Network Commercial	$6,566.79
Rate for Payer: MDX Hawaii PPO	$7,493.86

ROMOSOZUMAB-AQQG 210MG/2.34ML ( 105MG/1.17MLX2) SUBCUTANEOUS SYR

Facility

$2,695.76

Service Code	HCPCS J3111
Hospital Revenue Code	636
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$2,614.89
Rate for Payer: AlohaCare Medicaid	$12.19
Rate for Payer: AlohaCare Medicare	$12.19
Rate for Payer: Cash Price	$1,752.24
Rate for Payer: Cash Price	$1,752.24
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	$2,560.97
Rate for Payer: Health Management Network Commercial	$2,291.40
Rate for Payer: Humana Medicare	$12.19
Rate for Payer: Kaiser Permanente Commercial	$1,698.33
Rate for Payer: Kaiser Permanente Medicaid	$1,374.84
Rate for Payer: Kaiser Permanente Medicare	$12.19
Rate for Payer: MDX Hawaii PPO	$2,614.89
Rate for Payer: Ohana Health Plan Medicaid	$13.41
Rate for Payer: Ohana Health Plan Medicare	$12.19
Rate for Payer: UnitedHealthcare Medicaid	$1,617.46
Rate for Payer: UnitedHealthcare Medicare	$12.19
Rate for Payer: University Health Alliance Commercial	$1,964.94

Know your out-of-pocket cost for care.

All Charges