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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

METFORMIN 850 MG TABLET [14719]

Facility

IP

$5.00

Service Code	NDC 70010006401
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

METFORMIN 850 MG TABLET [14719]

Facility

IP

$5.00

Service Code	NDC 60687014311
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

METFORMIN 850 MG TABLET [14719]

Facility

OP

$5.00

Service Code	NDC 60687014301
Hospital Revenue Code	637
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$3.80
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$4.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3.80
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$3.80
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$3.80
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$3.80
Rate for Payer: Ohana Health Plan Medicare	$3.80
Rate for Payer: UnitedHealthcare Medicare	$3.80
Rate for Payer: University Health Alliance Commercial	$3.64

METFORMIN 850 MG TABLET [14719]

Facility

IP

$5.00

Service Code	NDC 60687014301
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

METFORMIN 850 MG TABLET [14719]

Facility

OP

$5.00

Service Code	NDC 70010006401
Hospital Revenue Code	637
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$3.80
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$4.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3.80
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$3.80
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$3.80
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$3.80
Rate for Payer: Ohana Health Plan Medicare	$3.80
Rate for Payer: UnitedHealthcare Medicare	$3.80
Rate for Payer: University Health Alliance Commercial	$3.64

METFORMIN 850 MG TABLET [14719]

Facility

OP

$5.00

Service Code	NDC 60687014311
Hospital Revenue Code	637
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$3.80
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$4.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3.80
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$3.80
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$3.80
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$3.80
Rate for Payer: Ohana Health Plan Medicare	$3.80
Rate for Payer: UnitedHealthcare Medicare	$3.80
Rate for Payer: University Health Alliance Commercial	$3.64

METHACHOLINE 0 MG TO 48 MG/3 ML (0 MG TO 16 MG/ML) NEBULIZATION SOLN [174646]

Facility

OP

$68.00

Service Code	HCPCS J7674
Hospital Revenue Code	636
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$34.00
Rate for Payer: AlohaCare Medicare	$51.68
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Devoted Health Medicare	$57.12
Rate for Payer: Hawaii Medical Service Association ABD	$1.73
Rate for Payer: Hawaii Medical Service Association Medicare	$51.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.73
Rate for Payer: Hawaii Western Management Group Commercial	$64.60
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$51.68
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$51.68
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$51.68
Rate for Payer: Ohana Health Plan Medicare	$51.68
Rate for Payer: UnitedHealthcare Medicaid	$40.80
Rate for Payer: UnitedHealthcare Medicare	$51.68
Rate for Payer: University Health Alliance Commercial	$49.57

METHACHOLINE 0 MG TO 48 MG/3 ML (0 MG TO 16 MG/ML) NEBULIZATION SOLN [174646]

Facility

IP

$68.00

Service Code	HCPCS J7674
Hospital Revenue Code	250
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: MDX Hawaii PPO	$65.96

METHACHOLINE CHLORIDE 0.1875 MG/3 ML (0.0625 MG/ML) NEBULIZATION SOLN [209711]

Facility

IP

$16.00

Service Code	NDC 64281011200
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

METHACHOLINE CHLORIDE 0.75 MG/3 ML (0.25 MG/ML) NEBULIZATION SOLUTION [209712]

Facility

IP

$16.00

Service Code	NDC 64281011300
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

METHACHOLINE CHLORIDE 0 MG/3 ML (0 MG/ML) NEBULIZATION SOLUTION [209732]

Facility

IP

$16.00

Service Code	NDC 64281011100
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

METHACHOLINE CHLORIDE 12 MG/3 ML (4 MG/ML) NEBULIZATION SOLUTION [209709]

Facility

IP

$16.00

Service Code	NDC 64281011500
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

METHACHOLINE CHLORIDE 3 MG/3 ML (1 MG/ML) NEBULIZATION SOLUTION [209708]

Facility

IP

$16.00

Service Code	NDC 64281011400
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

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

METHADONE 10 MG/ML ORAL CONCENTRATE [15996]

Facility

OP

$64.00

Service Code	NDC 00054355344
Hospital Revenue Code	637
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$62.08
Rate for Payer: AlohaCare Medicaid	$32.00
Rate for Payer: AlohaCare Medicare	$48.64
Rate for Payer: Cash Price	$38.40
Rate for Payer: Devoted Health Medicare	$53.76
Rate for Payer: Hawaii Medical Service Association Medicare	$48.64
Rate for Payer: Hawaii Western Management Group Commercial	$60.80
Rate for Payer: Health Management Network Commercial	$54.40
Rate for Payer: Humana Medicare	$48.64
Rate for Payer: Kaiser Permanente Commercial	$57.60
Rate for Payer: Kaiser Permanente Medicaid	$32.64
Rate for Payer: Kaiser Permanente Medicare	$48.64
Rate for Payer: MDX Hawaii PPO	$62.08
Rate for Payer: Ohana Health Plan Medicaid	$48.64
Rate for Payer: Ohana Health Plan Medicare	$48.64
Rate for Payer: UnitedHealthcare Medicare	$48.64
Rate for Payer: University Health Alliance Commercial	$46.65

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: Kaiser Permanente Commercial	$57.60
Rate for Payer: MDX Hawaii PPO	$62.08

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: Kaiser Permanente Commercial	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22

METHADONE 10 MG/ML ORAL CONCENTRATE [15996]

Facility

OP

$126.00

Service Code	NDC 00406412303
Hospital Revenue Code	637
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$122.22
Rate for Payer: AlohaCare Medicaid	$63.00
Rate for Payer: AlohaCare Medicare	$95.76
Rate for Payer: Cash Price	$75.60
Rate for Payer: Devoted Health Medicare	$105.84
Rate for Payer: Hawaii Medical Service Association Medicare	$95.76
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Humana Medicare	$95.76
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$95.76
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$95.76
Rate for Payer: Ohana Health Plan Medicare	$95.76
Rate for Payer: UnitedHealthcare Medicare	$95.76
Rate for Payer: University Health Alliance Commercial	$91.84

METHADONE 10 MG TABLET [4953]

Facility

OP

$2.00

Service Code	NDC 00054071020
Hospital Revenue Code	637
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$1.52
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.52
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$1.52
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$1.52
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$1.52
Rate for Payer: Ohana Health Plan Medicare	$1.52
Rate for Payer: UnitedHealthcare Medicare	$1.52
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: Kaiser Permanente Commercial	$1.80
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	$6.00
Max. Negotiated Rate	$11.64
Rate for Payer: AlohaCare Medicaid	$6.00
Rate for Payer: AlohaCare Medicare	$9.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Devoted Health Medicare	$10.08
Rate for Payer: Hawaii Medical Service Association Medicare	$9.12
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Humana Medicare	$9.12
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicare	$9.12
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: Ohana Health Plan Medicaid	$9.12
Rate for Payer: Ohana Health Plan Medicare	$9.12
Rate for Payer: UnitedHealthcare Medicare	$9.12
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: Kaiser Permanente Commercial	$10.80
Rate for Payer: MDX Hawaii PPO	$11.64

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: Kaiser Permanente Commercial	$2.70
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: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

METHIMAZOLE 5 MG TABLET [10553]

Facility

OP

$3.00

Service Code	NDC 60687066901
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

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