Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

methenamine hippurate 1 gm Tab [KMC]

Facility

$8.37

Service Code	NDC 65862078201
Hospital Revenue Code	250
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$8.12
Rate for Payer: AlohaCare Medicaid	$4.18
Rate for Payer: AlohaCare Medicare	$3.52
Rate for Payer: Cash Price	$5.44
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7.70
Rate for Payer: Devoted Health Medicare	$3.52
Rate for Payer: Hawaii Medical Service Association Medicare	$3.52
Rate for Payer: Hawaii Western Management Group Commercial	$7.95
Rate for Payer: Health Management Network Commercial	$7.11
Rate for Payer: Humana Medicare	$3.52
Rate for Payer: Kaiser Permanente Commercial	$7.53
Rate for Payer: Kaiser Permanente Medicaid	$4.27
Rate for Payer: Kaiser Permanente Medicare	$3.52
Rate for Payer: MDX Hawaii PPO	$8.12
Rate for Payer: Ohana Health Plan Medicaid	$3.52
Rate for Payer: Ohana Health Plan Medicare	$3.52
Rate for Payer: UnitedHealthcare Medicaid	$5.02
Rate for Payer: UnitedHealthcare Medicare	$3.52
Rate for Payer: University Health Alliance Commercial	$6.10

methenamine mandelate 1 gm Tab [KMC]

Facility

$6.66

Service Code	NDC 42799010601
Hospital Revenue Code	250
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$6.46
Rate for Payer: Cash Price	$4.33
Rate for Payer: Health Management Network Commercial	$5.66
Rate for Payer: Kaiser Permanente Commercial	$5.99
Rate for Payer: MDX Hawaii PPO	$6.46

methenamine mandelate 1 gm Tab [KMC]

Facility

$6.66

Service Code	NDC 42799010601
Hospital Revenue Code	250
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.46
Rate for Payer: AlohaCare Medicaid	$3.33
Rate for Payer: AlohaCare Medicare	$2.80
Rate for Payer: Cash Price	$4.33
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6.13
Rate for Payer: Devoted Health Medicare	$2.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2.80
Rate for Payer: Hawaii Western Management Group Commercial	$6.33
Rate for Payer: Health Management Network Commercial	$5.66
Rate for Payer: Humana Medicare	$2.80
Rate for Payer: Kaiser Permanente Commercial	$5.99
Rate for Payer: Kaiser Permanente Medicaid	$3.40
Rate for Payer: Kaiser Permanente Medicare	$2.80
Rate for Payer: MDX Hawaii PPO	$6.46
Rate for Payer: Ohana Health Plan Medicaid	$2.80
Rate for Payer: Ohana Health Plan Medicare	$2.80
Rate for Payer: UnitedHealthcare Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicare	$2.80
Rate for Payer: University Health Alliance Commercial	$4.85

methIMAzole 10 mg Tab [KMC]

Facility

$3.07

Service Code	NDC 23155007101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$2.98
Rate for Payer: Cash Price	$2.00
Rate for Payer: Health Management Network Commercial	$2.61
Rate for Payer: Kaiser Permanente Commercial	$2.76
Rate for Payer: MDX Hawaii PPO	$2.98

methIMAzole 10 mg Tab [KMC]

Facility

$3.07

Service Code	NDC 23155007101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$2.98
Rate for Payer: AlohaCare Medicaid	$1.53
Rate for Payer: AlohaCare Medicare	$1.29
Rate for Payer: Cash Price	$2.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.82
Rate for Payer: Devoted Health Medicare	$1.29
Rate for Payer: Hawaii Medical Service Association Medicare	$1.29
Rate for Payer: Hawaii Western Management Group Commercial	$2.92
Rate for Payer: Health Management Network Commercial	$2.61
Rate for Payer: Humana Medicare	$1.29
Rate for Payer: Kaiser Permanente Commercial	$2.76
Rate for Payer: Kaiser Permanente Medicaid	$1.57
Rate for Payer: Kaiser Permanente Medicare	$1.29
Rate for Payer: MDX Hawaii PPO	$2.98
Rate for Payer: Ohana Health Plan Medicaid	$1.29
Rate for Payer: Ohana Health Plan Medicare	$1.29
Rate for Payer: UnitedHealthcare Medicaid	$1.84
Rate for Payer: UnitedHealthcare Medicare	$1.29
Rate for Payer: University Health Alliance Commercial	$2.24

methimazole 5 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 72603031501
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
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 Tab [KMC]

Facility

$3.00

Service Code	NDC 72603031501
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

methocarbamol 500 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 60687055901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

methocarbamol 500 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 60687055901
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
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

methocarbamol 750 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 70010077001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

methocarbamol 750 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 70010077001
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
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

methotrexate 25 mg/0.5 mL Soln [KMC]

Facility

$1,305.60

Service Code	HCPCS J9250
Hospital Revenue Code	636
Min. Negotiated Rate	$1,109.76
Max. Negotiated Rate	$1,266.43
Rate for Payer: Cash Price	$848.64
Rate for Payer: Health Management Network Commercial	$1,109.76
Rate for Payer: Kaiser Permanente Commercial	$1,175.04
Rate for Payer: MDX Hawaii PPO	$1,266.43

methotrexate 25 mg/0.5 mL Soln [KMC]

Facility

$1,305.60

Service Code	HCPCS J9250
Hospital Revenue Code	636
Min. Negotiated Rate	$548.35
Max. Negotiated Rate	$1,266.43
Rate for Payer: AlohaCare Medicaid	$652.80
Rate for Payer: AlohaCare Medicare	$548.35
Rate for Payer: Cash Price	$848.64
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,201.15
Rate for Payer: Devoted Health Medicare	$548.35
Rate for Payer: Hawaii Medical Service Association Medicare	$548.35
Rate for Payer: Hawaii Western Management Group Commercial	$1,240.32
Rate for Payer: Health Management Network Commercial	$1,109.76
Rate for Payer: Humana Medicare	$548.35
Rate for Payer: Kaiser Permanente Commercial	$1,175.04
Rate for Payer: Kaiser Permanente Medicaid	$665.86
Rate for Payer: Kaiser Permanente Medicare	$548.35
Rate for Payer: MDX Hawaii PPO	$1,266.43
Rate for Payer: Ohana Health Plan Medicaid	$548.35
Rate for Payer: Ohana Health Plan Medicare	$548.35
Rate for Payer: UnitedHealthcare Medicaid	$783.36
Rate for Payer: UnitedHealthcare Medicare	$548.35
Rate for Payer: University Health Alliance Commercial	$951.65

methotrexate 2.5 mg Tab [KMC]

Facility

$16.04

Service Code	HCPCS J8610
Hospital Revenue Code	636
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$15.56
Rate for Payer: Cash Price	$10.43
Rate for Payer: Health Management Network Commercial	$13.63
Rate for Payer: Kaiser Permanente Commercial	$14.44
Rate for Payer: MDX Hawaii PPO	$15.56

methotrexate 2.5 mg Tab [KMC]

Facility

$16.04

Service Code	HCPCS J8610
Hospital Revenue Code	636
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$15.56
Rate for Payer: AlohaCare Medicaid	$8.02
Rate for Payer: AlohaCare Medicare	$6.74
Rate for Payer: Cash Price	$10.43
Rate for Payer: Cash Price	$10.43
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$14.76
Rate for Payer: Devoted Health Medicare	$6.74
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.20
Rate for Payer: Hawaii Medical Service Association Medicare	$6.74
Rate for Payer: Hawaii Western Management Group Commercial	$15.24
Rate for Payer: Health Management Network Commercial	$13.63
Rate for Payer: Humana Medicare	$6.74
Rate for Payer: Kaiser Permanente Commercial	$14.44
Rate for Payer: Kaiser Permanente Medicaid	$8.18
Rate for Payer: Kaiser Permanente Medicare	$6.74
Rate for Payer: MDX Hawaii PPO	$15.56
Rate for Payer: Ohana Health Plan Medicaid	$6.74
Rate for Payer: Ohana Health Plan Medicare	$6.74
Rate for Payer: UnitedHealthcare Medicaid	$9.62
Rate for Payer: UnitedHealthcare Medicare	$6.74
Rate for Payer: University Health Alliance Commercial	$11.69

methotrexate 50 mg/ 2 mL preserv-free Sol [KMC]

Facility

$9.80

Service Code	HCPCS J9250
Hospital Revenue Code	636
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$9.51
Rate for Payer: AlohaCare Medicaid	$4.90
Rate for Payer: AlohaCare Medicare	$4.12
Rate for Payer: Cash Price	$6.37
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$9.02
Rate for Payer: Devoted Health Medicare	$4.12
Rate for Payer: Hawaii Medical Service Association Medicare	$4.12
Rate for Payer: Hawaii Western Management Group Commercial	$9.31
Rate for Payer: Health Management Network Commercial	$8.33
Rate for Payer: Humana Medicare	$4.12
Rate for Payer: Kaiser Permanente Commercial	$8.82
Rate for Payer: Kaiser Permanente Medicaid	$5.00
Rate for Payer: Kaiser Permanente Medicare	$4.12
Rate for Payer: MDX Hawaii PPO	$9.51
Rate for Payer: Ohana Health Plan Medicaid	$4.12
Rate for Payer: Ohana Health Plan Medicare	$4.12
Rate for Payer: UnitedHealthcare Medicaid	$5.88
Rate for Payer: UnitedHealthcare Medicare	$4.12
Rate for Payer: University Health Alliance Commercial	$7.14

methotrexate 50 mg/ 2 mL preserv-free Sol [KMC]

Facility

$9.80

Service Code	HCPCS J9250
Hospital Revenue Code	636
Min. Negotiated Rate	$8.33
Max. Negotiated Rate	$9.51
Rate for Payer: Cash Price	$6.37
Rate for Payer: Health Management Network Commercial	$8.33
Rate for Payer: Kaiser Permanente Commercial	$8.82
Rate for Payer: MDX Hawaii PPO	$9.51

Methylmalonic Acid, Serum DLS

Facility

$300.00

Service Code	HCPCS 83921
Hospital Charge Code	422839215
Hospital Revenue Code	301
Min. Negotiated Rate	$21.21
Max. Negotiated Rate	$291.00
Rate for Payer: AlohaCare Medicaid	$150.00
Rate for Payer: AlohaCare Medicare	$126.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$276.00
Rate for Payer: Devoted Health Medicare	$126.00
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$22.75
Rate for Payer: Hawaii Medical Service Association Commercial	$26.51
Rate for Payer: Hawaii Medical Service Association Medicare	$126.00
Rate for Payer: Hawaii Western Management Group Commercial	$21.21
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Humana Medicare	$126.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: Kaiser Permanente Medicare	$126.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: Ohana Health Plan Medicaid	$126.00
Rate for Payer: Ohana Health Plan Medicare	$126.00
Rate for Payer: UnitedHealthcare Medicaid	$22.75
Rate for Payer: UnitedHealthcare Medicare	$126.00
Rate for Payer: University Health Alliance Commercial	$42.55

Methylmalonic Acid, Serum DLS

Facility

$300.00

Service Code	HCPCS 83921
Hospital Charge Code	422839215
Hospital Revenue Code	301
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: MDX Hawaii PPO	$291.00

methylphenidate 10 mg Tab [KMC]

Facility

$4.00

Service Code	NDC 00115180101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$1.68
Rate for Payer: Cash Price	$2.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.68
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.68
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$1.68
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$1.68
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$1.68
Rate for Payer: Ohana Health Plan Medicare	$1.68
Rate for Payer: UnitedHealthcare Medicaid	$2.40
Rate for Payer: UnitedHealthcare Medicare	$1.68
Rate for Payer: University Health Alliance Commercial	$2.92

methylphenidate 10 mg Tab [KMC]

Facility

$4.00

Service Code	NDC 00115180101
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.60
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

methylphenidate 2.5 mg Chew Tab [KMC]

Facility

$12.63

Service Code	NDC 64980022101
Hospital Revenue Code	250
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$12.25
Rate for Payer: AlohaCare Medicaid	$6.32
Rate for Payer: AlohaCare Medicare	$5.30
Rate for Payer: Cash Price	$8.21
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$11.62
Rate for Payer: Devoted Health Medicare	$5.30
Rate for Payer: Hawaii Medical Service Association Medicare	$5.30
Rate for Payer: Hawaii Western Management Group Commercial	$12.00
Rate for Payer: Health Management Network Commercial	$10.74
Rate for Payer: Humana Medicare	$5.30
Rate for Payer: Kaiser Permanente Commercial	$11.37
Rate for Payer: Kaiser Permanente Medicaid	$6.44
Rate for Payer: Kaiser Permanente Medicare	$5.30
Rate for Payer: MDX Hawaii PPO	$12.25
Rate for Payer: Ohana Health Plan Medicaid	$5.30
Rate for Payer: Ohana Health Plan Medicare	$5.30
Rate for Payer: UnitedHealthcare Medicaid	$7.58
Rate for Payer: UnitedHealthcare Medicare	$5.30
Rate for Payer: University Health Alliance Commercial	$9.21

methylphenidate 2.5 mg Chew Tab [KMC]

Facility

$12.63

Service Code	NDC 64980022101
Hospital Revenue Code	250
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$12.25
Rate for Payer: Cash Price	$8.21
Rate for Payer: Health Management Network Commercial	$10.74
Rate for Payer: Kaiser Permanente Commercial	$11.37
Rate for Payer: MDX Hawaii PPO	$12.25

methylphenidate 5 mg Tab [KMC]

Facility

$7.99

Service Code	NDC 68084080521
Hospital Revenue Code	250
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$7.75
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$3.36
Rate for Payer: Cash Price	$5.19
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7.35
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3.36
Rate for Payer: Hawaii Western Management Group Commercial	$7.59
Rate for Payer: Health Management Network Commercial	$6.79
Rate for Payer: Humana Medicare	$3.36
Rate for Payer: Kaiser Permanente Commercial	$7.19
Rate for Payer: Kaiser Permanente Medicaid	$4.07
Rate for Payer: Kaiser Permanente Medicare	$3.36
Rate for Payer: MDX Hawaii PPO	$7.75
Rate for Payer: Ohana Health Plan Medicaid	$3.36
Rate for Payer: Ohana Health Plan Medicare	$3.36
Rate for Payer: UnitedHealthcare Medicaid	$4.79
Rate for Payer: UnitedHealthcare Medicare	$3.36
Rate for Payer: University Health Alliance Commercial	$5.82

methylphenidate 5 mg Tab [KMC]

Facility

$7.99

Service Code	NDC 68084080521
Hospital Revenue Code	250
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$7.75
Rate for Payer: Cash Price	$5.19
Rate for Payer: Health Management Network Commercial	$6.79
Rate for Payer: Kaiser Permanente Commercial	$7.19
Rate for Payer: MDX Hawaii PPO	$7.75

Know your out-of-pocket cost for care.

All Charges