Hilo Benioff Medical Center

All Charges

Charge

Type

Setting

Price

METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION [10581]

Facility

$66.00

Service Code	HCPCS J2919
Hospital Revenue Code	250
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cash Price	$43.80
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: MDX Hawaii PPO	$70.81

METHYLPREDNISOLONE SOD SUCC 500 MG/8ML BWFI IJ (WET SOLR VIAL) [43010581]

Facility

$73.00

Service Code	HCPCS J2930
Hospital Revenue Code	250
Min. Negotiated Rate	$62.05
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$43.80
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: MDX Hawaii PPO	$70.81

METHYLPREDNISOLONE SOD SUCC 500 MG/8ML BWFI IJ (WET SOLR VIAL) [43010581]

Facility

$73.00

Service Code	HCPCS J2930
Hospital Revenue Code	636
Min. Negotiated Rate	$37.23
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$43.80
Rate for Payer: Hawaii Western Management Group Commercial	$69.35
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Kaiser Permanente Commercial	$45.99
Rate for Payer: Kaiser Permanente Medicaid	$37.23
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: UnitedHealthcare Medicaid	$43.80
Rate for Payer: University Health Alliance Commercial	$53.21

METHYLPREDNISOLONE SOD SUCC (PF) 1,000 MG/8 ML INTRAVENOUS SOLUTION [191023]

Facility

$166.00

Service Code	HCPCS J2919
Hospital Revenue Code	250
Min. Negotiated Rate	$141.10
Max. Negotiated Rate	$161.02
Rate for Payer: Cash Price	$99.60
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: MDX Hawaii PPO	$161.02

METHYLPREDNISOLONE SOD SUCC (PF) 1,000 MG/8 ML INTRAVENOUS SOLUTION [191023]

Facility

$166.00

Service Code	HCPCS J2919
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$161.02
Rate for Payer: Cash Price	$99.60
Rate for Payer: Cash Price	$99.60
Rate for Payer: Hawaii Medical Service Association ABD	$0.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.26
Rate for Payer: Hawaii Western Management Group Commercial	$157.70
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Kaiser Permanente Commercial	$104.58
Rate for Payer: Kaiser Permanente Medicaid	$84.66
Rate for Payer: MDX Hawaii PPO	$161.02
Rate for Payer: UnitedHealthcare Medicaid	$99.60
Rate for Payer: University Health Alliance Commercial	$121.00

METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION [191021]

Facility

$32.00

Service Code	HCPCS J2919
Hospital Revenue Code	250
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cash Price	$18.60
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: MDX Hawaii PPO	$31.04
Rate for Payer: MDX Hawaii PPO	$30.07

METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION [191021]

Facility

$31.00

Service Code	HCPCS J2919
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Cash Price	$18.60
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cash Price	$19.20
Rate for Payer: Hawaii Medical Service Association ABD	$0.26
Rate for Payer: Hawaii Medical Service Association ABD	$0.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.26
Rate for Payer: Hawaii Western Management Group Commercial	$29.45
Rate for Payer: Hawaii Western Management Group Commercial	$30.40
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Kaiser Permanente Commercial	$19.53
Rate for Payer: Kaiser Permanente Commercial	$20.16
Rate for Payer: Kaiser Permanente Medicaid	$16.32
Rate for Payer: Kaiser Permanente Medicaid	$15.81
Rate for Payer: MDX Hawaii PPO	$31.04
Rate for Payer: MDX Hawaii PPO	$30.07
Rate for Payer: UnitedHealthcare Medicaid	$18.60
Rate for Payer: UnitedHealthcare Medicaid	$19.20
Rate for Payer: University Health Alliance Commercial	$22.60
Rate for Payer: University Health Alliance Commercial	$23.32

METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION [191020]

Facility

$24.00

Service Code	HCPCS J2919
Hospital Revenue Code	250
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: MDX Hawaii PPO	$23.28

METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION [191020]

Facility

$24.00

Service Code	HCPCS J2919
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Hawaii Medical Service Association ABD	$0.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.26
Rate for Payer: Hawaii Western Management Group Commercial	$22.80
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Kaiser Permanente Commercial	$15.12
Rate for Payer: Kaiser Permanente Medicaid	$12.24
Rate for Payer: MDX Hawaii PPO	$23.28
Rate for Payer: UnitedHealthcare Medicaid	$14.40
Rate for Payer: University Health Alliance Commercial	$17.49

METHYL SALICYLATE 30 %-MENTHOL 10 % TOPICAL CREAM [21507]

Facility

$17.00

Service Code	NDC 00883000000
Hospital Revenue Code	637
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$10.71
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: University Health Alliance Commercial	$12.39

METHYL SALICYLATE 30 %-MENTHOL 10 % TOPICAL CREAM [21507]

Facility

$17.00

Service Code	NDC 00883000000
Hospital Revenue Code	250
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: MDX Hawaii PPO	$16.49

METOCLOPRAMIDE 10 MG TABLET [5005]

Facility

$4.00

Service Code	NDC 51079088820
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

METOCLOPRAMIDE 10 MG TABLET [5005]

Facility

$4.00

Service Code	NDC 51079088820
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: MDX Hawaii PPO	$3.88

METOCLOPRAMIDE 10 MG TABLET [5005]

Facility

$4.00

Service Code	NDC 51079088801
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: MDX Hawaii PPO	$3.88

METOCLOPRAMIDE 10 MG TABLET [5005]

Facility

$4.00

Service Code	NDC 51079088801
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION [77710]

Facility

$88.00

Service Code	NDC 00121057616
Hospital Revenue Code	250
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$52.80
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: MDX Hawaii PPO	$85.36

METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION [77710]

Facility

$18.00

Service Code	NDC 00121157610
Hospital Revenue Code	250
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: MDX Hawaii PPO	$17.46

METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION [5002]

Facility

$7.00

Service Code	HCPCS J2765
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: MDX Hawaii PPO	$14.55

METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION [5002]

Facility

$15.00

Service Code	HCPCS J2765
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$4.20
Rate for Payer: Cash Price	$4.20
Rate for Payer: Hawaii Medical Service Association ABD	$1.00
Rate for Payer: Hawaii Medical Service Association ABD	$1.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.00
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Commercial	$4.41
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: UnitedHealthcare Medicaid	$9.00
Rate for Payer: UnitedHealthcare Medicaid	$4.20
Rate for Payer: University Health Alliance Commercial	$10.93
Rate for Payer: University Health Alliance Commercial	$5.10

METOCLOPRAMIDE 5 MG TABLET [5006]

Facility

$3.00

Service Code	NDC 60687062001
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

METOCLOPRAMIDE 5 MG TABLET [5006]

Facility

$3.00

Service Code	NDC 60687062011
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

METOCLOPRAMIDE 5 MG TABLET [5006]

Facility

$3.00

Service Code	NDC 60687062011
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

METOCLOPRAMIDE 5 MG TABLET [5006]

Facility

$3.00

Service Code	NDC 60687062001
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

METOCLOPRAMIDE TABLETS (REGLAN) 10 MG (TAKE HOME) [4080374]

Facility

$15.00

Service Code	NDC 00004080162
Hospital Revenue Code	253
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: MDX Hawaii PPO	$14.55

METOCLOPRAMIDE TABLETS (REGLAN) 10 MG (TAKE HOME) [4080374]

Facility

$15.00

Service Code	NDC 00004080162
Hospital Revenue Code	253
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: University Health Alliance Commercial	$10.93

Know your out-of-pocket cost for care.

All Charges