|
METHACHOLINE CHLORIDE 48 MG/3 ML (16 MG/ML) NEBULIZATION SOLUTION [209710]
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
NDC 64281011600
|
|
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: MDX Hawaii PPO |
$15.52
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE [15996]
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
NDC 00406412303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE [15996]
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
NDC 00054355344
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.64 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$60.80
|
| Rate for Payer: Health Management Network Commercial |
$54.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.64
|
| Rate for Payer: MDX Hawaii PPO |
$62.08
|
| Rate for Payer: University Health Alliance Commercial |
$46.65
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE [15996]
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
NDC 00406412303
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.70
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.26
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
| Rate for Payer: University Health Alliance Commercial |
$91.84
|
|
|
METHADONE 10 MG/ML ORAL CONCENTRATE [15996]
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
NDC 00054355344
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Health Management Network Commercial |
$54.40
|
| Rate for Payer: MDX Hawaii PPO |
$62.08
|
|
|
METHADONE 10 MG TABLET [4953]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 00054071020
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
|
|
METHADONE 10 MG TABLET [4953]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 00054071020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
|
|
METHADONE ORAL SOLUTION 10 MG/ML 5 ML SYRINGE [4080234]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 00004080067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.40
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.12
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
| Rate for Payer: University Health Alliance Commercial |
$8.75
|
|
|
METHADONE ORAL SOLUTION 10 MG/ML 5 ML SYRINGE [4080234]
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 00004080067
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
|
|
METHIMAZOLE 5 MG TABLET [10553]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687066911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
METHIMAZOLE 5 MG TABLET [10553]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687035701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
METHIMAZOLE 5 MG TABLET [10553]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687066901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
METHIMAZOLE 5 MG TABLET [10553]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687066911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
METHIMAZOLE 5 MG TABLET [10553]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687035701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
METHIMAZOLE 5 MG TABLET [10553]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687066901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [127749]
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS J2800
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$36.86 |
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.35
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Health Management Network Commercial |
$32.30
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.77
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
| Rate for Payer: MDX Hawaii PPO |
$36.86
|
| Rate for Payer: MDX Hawaii PPO |
$70.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.20
|
| Rate for Payer: University Health Alliance Commercial |
$27.70
|
| Rate for Payer: University Health Alliance Commercial |
$19.68
|
| Rate for Payer: University Health Alliance Commercial |
$53.21
|
|
|
METHOCARBAMOL 100 MG/ML INJECTION SOLUTION [127749]
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS J2800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.05 |
| Max. Negotiated Rate |
$70.81 |
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Health Management Network Commercial |
$32.30
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
| Rate for Payer: MDX Hawaii PPO |
$70.81
|
| Rate for Payer: MDX Hawaii PPO |
$36.86
|
|
|
METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION [82181]
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS J9260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$120.70 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: MDX Hawaii PPO |
$137.74
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
|
|
METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION [82181]
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS J9260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$134.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.45
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.81
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
| Rate for Payer: MDX Hawaii PPO |
$137.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$85.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.60
|
| Rate for Payer: University Health Alliance Commercial |
$103.50
|
| Rate for Payer: University Health Alliance Commercial |
$22.60
|
|
|
METHOTREXATE SODIUM 2.5 MG TABLET [13594]
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS J8610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$12.61 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
|
|
METHOTREXATE SODIUM 2.5 MG TABLET [13594]
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS J8610
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$12.61 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.63
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.40
|
| Rate for Payer: University Health Alliance Commercial |
$9.48
|
| Rate for Payer: University Health Alliance Commercial |
$13.85
|
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION [117030]
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J9260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$147.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.10
|
| Rate for Payer: Health Management Network Commercial |
$32.30
|
| Rate for Payer: Health Management Network Commercial |
$131.75
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.38
|
| Rate for Payer: MDX Hawaii PPO |
$36.86
|
| Rate for Payer: MDX Hawaii PPO |
$150.35
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.80
|
| Rate for Payer: University Health Alliance Commercial |
$27.70
|
| Rate for Payer: University Health Alliance Commercial |
$13.12
|
| Rate for Payer: University Health Alliance Commercial |
$112.98
|
|
|
METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION [117030]
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J9260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Health Management Network Commercial |
$131.75
|
| Rate for Payer: Health Management Network Commercial |
$32.30
|
| Rate for Payer: MDX Hawaii PPO |
$150.35
|
| Rate for Payer: MDX Hawaii PPO |
$36.86
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION [134059]
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
HCPCS Q9968
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$598.40 |
| Max. Negotiated Rate |
$682.88 |
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Health Management Network Commercial |
$598.40
|
| Rate for Payer: MDX Hawaii PPO |
$682.88
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION [10571]
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS J2210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.90 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: MDX Hawaii PPO |
$91.18
|
|
