Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

methylPREDNISolone 125 mg / 2 mL REC [KMC]

Facility

$46.73

Service Code	HCPCS J1010
Hospital Revenue Code	636
Min. Negotiated Rate	$39.72
Max. Negotiated Rate	$45.33
Rate for Payer: Cash Price	$30.37
Rate for Payer: Health Management Network Commercial	$39.72
Rate for Payer: Kaiser Permanente Commercial	$42.06
Rate for Payer: MDX Hawaii PPO	$45.33

methylPREDNISolone 125 mg / 2 mL REC [KMC]

Facility

$46.73

Service Code	HCPCS J1010
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$45.33
Rate for Payer: AlohaCare Medicaid	$23.36
Rate for Payer: AlohaCare Medicare	$19.63
Rate for Payer: Cash Price	$30.37
Rate for Payer: Cash Price	$30.37
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$42.99
Rate for Payer: Devoted Health Medicare	$19.63
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.12
Rate for Payer: Hawaii Medical Service Association Medicare	$19.63
Rate for Payer: Hawaii Western Management Group Commercial	$44.39
Rate for Payer: Health Management Network Commercial	$39.72
Rate for Payer: Humana Medicare	$19.63
Rate for Payer: Kaiser Permanente Commercial	$42.06
Rate for Payer: Kaiser Permanente Medicaid	$23.83
Rate for Payer: Kaiser Permanente Medicare	$19.63
Rate for Payer: MDX Hawaii PPO	$45.33
Rate for Payer: Ohana Health Plan Medicaid	$19.63
Rate for Payer: Ohana Health Plan Medicare	$19.63
Rate for Payer: UnitedHealthcare Medicaid	$28.04
Rate for Payer: UnitedHealthcare Medicare	$19.63
Rate for Payer: University Health Alliance Commercial	$34.06

methylPREDNISolone 40 mg / 1 mL REC [KMC]

Facility

$29.02

Service Code	HCPCS J1010
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$28.15
Rate for Payer: AlohaCare Medicaid	$14.51
Rate for Payer: AlohaCare Medicare	$12.19
Rate for Payer: Cash Price	$18.86
Rate for Payer: Cash Price	$18.86
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$26.70
Rate for Payer: Devoted Health Medicare	$12.19
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.12
Rate for Payer: Hawaii Medical Service Association Medicare	$12.19
Rate for Payer: Hawaii Western Management Group Commercial	$27.57
Rate for Payer: Health Management Network Commercial	$24.67
Rate for Payer: Humana Medicare	$12.19
Rate for Payer: Kaiser Permanente Commercial	$26.12
Rate for Payer: Kaiser Permanente Medicaid	$14.80
Rate for Payer: Kaiser Permanente Medicare	$12.19
Rate for Payer: MDX Hawaii PPO	$28.15
Rate for Payer: Ohana Health Plan Medicaid	$12.19
Rate for Payer: Ohana Health Plan Medicare	$12.19
Rate for Payer: UnitedHealthcare Medicaid	$17.41
Rate for Payer: UnitedHealthcare Medicare	$12.19
Rate for Payer: University Health Alliance Commercial	$21.15

methylPREDNISolone 40 mg / 1 mL REC [KMC]

Facility

$29.02

Service Code	HCPCS J1010
Hospital Revenue Code	636
Min. Negotiated Rate	$24.67
Max. Negotiated Rate	$28.15
Rate for Payer: Cash Price	$18.86
Rate for Payer: Health Management Network Commercial	$24.67
Rate for Payer: Kaiser Permanente Commercial	$26.12
Rate for Payer: MDX Hawaii PPO	$28.15

methylPREDNISolone 4 mg Tab[KMC]

Facility

$5.72

Service Code	HCPCS J7509
Hospital Revenue Code	636
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$5.55
Rate for Payer: Cash Price	$3.72
Rate for Payer: Health Management Network Commercial	$4.86
Rate for Payer: Kaiser Permanente Commercial	$5.15
Rate for Payer: MDX Hawaii PPO	$5.55

methylPREDNISolone 4 mg Tab[KMC]

Facility

$5.72

Service Code	HCPCS J7509
Hospital Revenue Code	636
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$5.55
Rate for Payer: AlohaCare Medicaid	$2.86
Rate for Payer: AlohaCare Medicare	$2.40
Rate for Payer: Cash Price	$3.72
Rate for Payer: Cash Price	$3.72
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.26
Rate for Payer: Devoted Health Medicare	$2.40
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.23
Rate for Payer: Hawaii Medical Service Association Medicare	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$5.43
Rate for Payer: Health Management Network Commercial	$4.86
Rate for Payer: Humana Medicare	$2.40
Rate for Payer: Kaiser Permanente Commercial	$5.15
Rate for Payer: Kaiser Permanente Medicaid	$2.92
Rate for Payer: Kaiser Permanente Medicare	$2.40
Rate for Payer: MDX Hawaii PPO	$5.55
Rate for Payer: Ohana Health Plan Medicaid	$2.40
Rate for Payer: Ohana Health Plan Medicare	$2.40
Rate for Payer: UnitedHealthcare Medicaid	$3.43
Rate for Payer: UnitedHealthcare Medicare	$2.40
Rate for Payer: University Health Alliance Commercial	$4.17

methylPREDNISolone 4 mg Tapering Dose Pack [KMC]

Facility

$6.60

Service Code	HCPCS J7509
Hospital Revenue Code	636
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$6.40
Rate for Payer: Cash Price	$4.29
Rate for Payer: Health Management Network Commercial	$5.61
Rate for Payer: Kaiser Permanente Commercial	$5.94
Rate for Payer: MDX Hawaii PPO	$6.40

methylPREDNISolone 4 mg Tapering Dose Pack [KMC]

Facility

$6.60

Service Code	HCPCS J7509
Hospital Revenue Code	636
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$6.40
Rate for Payer: AlohaCare Medicaid	$3.30
Rate for Payer: AlohaCare Medicare	$2.77
Rate for Payer: Cash Price	$4.29
Rate for Payer: Cash Price	$4.29
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6.07
Rate for Payer: Devoted Health Medicare	$2.77
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.23
Rate for Payer: Hawaii Medical Service Association Medicare	$2.77
Rate for Payer: Hawaii Western Management Group Commercial	$6.27
Rate for Payer: Health Management Network Commercial	$5.61
Rate for Payer: Humana Medicare	$2.77
Rate for Payer: Kaiser Permanente Commercial	$5.94
Rate for Payer: Kaiser Permanente Medicaid	$3.37
Rate for Payer: Kaiser Permanente Medicare	$2.77
Rate for Payer: MDX Hawaii PPO	$6.40
Rate for Payer: Ohana Health Plan Medicaid	$2.77
Rate for Payer: Ohana Health Plan Medicare	$2.77
Rate for Payer: UnitedHealthcare Medicaid	$3.96
Rate for Payer: UnitedHealthcare Medicare	$2.77
Rate for Payer: University Health Alliance Commercial	$4.81

methylPREDNISolone 80 mg/mL Susp [KMC]

Facility

$78.34

Service Code	HCPCS J1010
Hospital Revenue Code	636
Min. Negotiated Rate	$66.59
Max. Negotiated Rate	$75.99
Rate for Payer: Cash Price	$50.92
Rate for Payer: Health Management Network Commercial	$66.59
Rate for Payer: Kaiser Permanente Commercial	$70.51
Rate for Payer: MDX Hawaii PPO	$75.99

methylPREDNISolone 80 mg/mL Susp [KMC]

Facility

$78.34

Service Code	HCPCS J1010
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$75.99
Rate for Payer: AlohaCare Medicaid	$39.17
Rate for Payer: AlohaCare Medicare	$32.90
Rate for Payer: Cash Price	$50.92
Rate for Payer: Cash Price	$50.92
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$72.07
Rate for Payer: Devoted Health Medicare	$32.90
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.12
Rate for Payer: Hawaii Medical Service Association Medicare	$32.90
Rate for Payer: Hawaii Western Management Group Commercial	$74.42
Rate for Payer: Health Management Network Commercial	$66.59
Rate for Payer: Humana Medicare	$32.90
Rate for Payer: Kaiser Permanente Commercial	$70.51
Rate for Payer: Kaiser Permanente Medicaid	$39.95
Rate for Payer: Kaiser Permanente Medicare	$32.90
Rate for Payer: MDX Hawaii PPO	$75.99
Rate for Payer: Ohana Health Plan Medicaid	$32.90
Rate for Payer: Ohana Health Plan Medicare	$32.90
Rate for Payer: UnitedHealthcare Medicaid	$47.00
Rate for Payer: UnitedHealthcare Medicare	$32.90
Rate for Payer: University Health Alliance Commercial	$57.10

metoclopramide 10 mg/2 mL Inj Soln [KMC]

Facility

$2.84

Service Code	HCPCS J2765
Hospital Revenue Code	636
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$2.75
Rate for Payer: Cash Price	$1.85
Rate for Payer: Health Management Network Commercial	$2.41
Rate for Payer: Kaiser Permanente Commercial	$2.56
Rate for Payer: MDX Hawaii PPO	$2.75

metoclopramide 10 mg/2 mL Inj Soln [KMC]

Facility

$2.84

Service Code	HCPCS J2765
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.75
Rate for Payer: AlohaCare Medicaid	$1.42
Rate for Payer: AlohaCare Medicare	$1.19
Rate for Payer: Cash Price	$1.85
Rate for Payer: Cash Price	$1.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.61
Rate for Payer: Devoted Health Medicare	$1.19
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1.19
Rate for Payer: Hawaii Western Management Group Commercial	$2.70
Rate for Payer: Health Management Network Commercial	$2.41
Rate for Payer: Humana Medicare	$1.19
Rate for Payer: Kaiser Permanente Commercial	$2.56
Rate for Payer: Kaiser Permanente Medicaid	$1.45
Rate for Payer: Kaiser Permanente Medicare	$1.19
Rate for Payer: MDX Hawaii PPO	$2.75
Rate for Payer: Ohana Health Plan Medicaid	$1.19
Rate for Payer: Ohana Health Plan Medicare	$1.19
Rate for Payer: UnitedHealthcare Medicaid	$1.70
Rate for Payer: UnitedHealthcare Medicare	$1.19
Rate for Payer: University Health Alliance Commercial	$2.07

metoclopramide 10 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 68084009101
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

metoclopramide 10 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 68084009101
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

metoclopramide 5 mg/5 mL Syrup [KMC]

Facility

$0.85

Service Code	NDC 62559019016
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.82
Rate for Payer: AlohaCare Medicaid	$0.43
Rate for Payer: AlohaCare Medicare	$0.36
Rate for Payer: Cash Price	$0.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.78
Rate for Payer: Devoted Health Medicare	$0.36
Rate for Payer: Hawaii Medical Service Association Medicare	$0.36
Rate for Payer: Hawaii Western Management Group Commercial	$0.81
Rate for Payer: Health Management Network Commercial	$0.72
Rate for Payer: Humana Medicare	$0.36
Rate for Payer: Kaiser Permanente Commercial	$0.77
Rate for Payer: Kaiser Permanente Medicaid	$0.43
Rate for Payer: Kaiser Permanente Medicare	$0.36
Rate for Payer: MDX Hawaii PPO	$0.82
Rate for Payer: Ohana Health Plan Medicaid	$0.36
Rate for Payer: Ohana Health Plan Medicare	$0.36
Rate for Payer: UnitedHealthcare Medicaid	$0.51
Rate for Payer: UnitedHealthcare Medicare	$0.36
Rate for Payer: University Health Alliance Commercial	$0.62

metoclopramide 5 mg/5 mL Syrup [KMC]

Facility

$0.85

Service Code	NDC 62559019016
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.82
Rate for Payer: Cash Price	$0.55
Rate for Payer: Health Management Network Commercial	$0.72
Rate for Payer: Kaiser Permanente Commercial	$0.77
Rate for Payer: MDX Hawaii PPO	$0.82

metoclopramide 5 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 16714006104
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

metoclopramide 5 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 16714006104
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

metolazone 5 mg Tab [KMC]

Facility

$9.42

Service Code	NDC 62332053331
Hospital Revenue Code	250
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$9.14
Rate for Payer: AlohaCare Medicaid	$4.71
Rate for Payer: AlohaCare Medicare	$3.96
Rate for Payer: Cash Price	$6.12
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$8.67
Rate for Payer: Devoted Health Medicare	$3.96
Rate for Payer: Hawaii Medical Service Association Medicare	$3.96
Rate for Payer: Hawaii Western Management Group Commercial	$8.95
Rate for Payer: Health Management Network Commercial	$8.01
Rate for Payer: Humana Medicare	$3.96
Rate for Payer: Kaiser Permanente Commercial	$8.48
Rate for Payer: Kaiser Permanente Medicaid	$4.80
Rate for Payer: Kaiser Permanente Medicare	$3.96
Rate for Payer: MDX Hawaii PPO	$9.14
Rate for Payer: Ohana Health Plan Medicaid	$3.96
Rate for Payer: Ohana Health Plan Medicare	$3.96
Rate for Payer: UnitedHealthcare Medicaid	$5.65
Rate for Payer: UnitedHealthcare Medicare	$3.96
Rate for Payer: University Health Alliance Commercial	$6.87

metolazone 5 mg Tab [KMC]

Facility

$9.42

Service Code	NDC 62332053331
Hospital Revenue Code	250
Min. Negotiated Rate	$8.01
Max. Negotiated Rate	$9.14
Rate for Payer: Cash Price	$6.12
Rate for Payer: Health Management Network Commercial	$8.01
Rate for Payer: Kaiser Permanente Commercial	$8.48
Rate for Payer: MDX Hawaii PPO	$9.14

metoprolol 100 mg ER Tab [KMC]

Facility

$6.48

Service Code	NDC 72603014401
Hospital Revenue Code	250
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$6.29
Rate for Payer: AlohaCare Medicaid	$3.24
Rate for Payer: AlohaCare Medicare	$2.72
Rate for Payer: Cash Price	$4.21
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.96
Rate for Payer: Devoted Health Medicare	$2.72
Rate for Payer: Hawaii Medical Service Association Medicare	$2.72
Rate for Payer: Hawaii Western Management Group Commercial	$6.16
Rate for Payer: Health Management Network Commercial	$5.51
Rate for Payer: Humana Medicare	$2.72
Rate for Payer: Kaiser Permanente Commercial	$5.83
Rate for Payer: Kaiser Permanente Medicaid	$3.30
Rate for Payer: Kaiser Permanente Medicare	$2.72
Rate for Payer: MDX Hawaii PPO	$6.29
Rate for Payer: Ohana Health Plan Medicaid	$2.72
Rate for Payer: Ohana Health Plan Medicare	$2.72
Rate for Payer: UnitedHealthcare Medicaid	$3.89
Rate for Payer: UnitedHealthcare Medicare	$2.72
Rate for Payer: University Health Alliance Commercial	$4.72

metoprolol 100 mg ER Tab [KMC]

Facility

$6.48

Service Code	NDC 72603014401
Hospital Revenue Code	250
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$6.29
Rate for Payer: Cash Price	$4.21
Rate for Payer: Health Management Network Commercial	$5.51
Rate for Payer: Kaiser Permanente Commercial	$5.83
Rate for Payer: MDX Hawaii PPO	$6.29

metoprolol 100 mg Tab [KMC]

Facility

$3.20

Service Code	NDC 57664016752
Hospital Revenue Code	250
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$3.10
Rate for Payer: Cash Price	$2.08
Rate for Payer: Health Management Network Commercial	$2.72
Rate for Payer: Kaiser Permanente Commercial	$2.88
Rate for Payer: MDX Hawaii PPO	$3.10

metoprolol 100 mg Tab [KMC]

Facility

$3.20

Service Code	NDC 57664016752
Hospital Revenue Code	250
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$3.10
Rate for Payer: AlohaCare Medicaid	$1.60
Rate for Payer: AlohaCare Medicare	$1.34
Rate for Payer: Cash Price	$2.08
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.94
Rate for Payer: Devoted Health Medicare	$1.34
Rate for Payer: Hawaii Medical Service Association Medicare	$1.34
Rate for Payer: Hawaii Western Management Group Commercial	$3.04
Rate for Payer: Health Management Network Commercial	$2.72
Rate for Payer: Humana Medicare	$1.34
Rate for Payer: Kaiser Permanente Commercial	$2.88
Rate for Payer: Kaiser Permanente Medicaid	$1.63
Rate for Payer: Kaiser Permanente Medicare	$1.34
Rate for Payer: MDX Hawaii PPO	$3.10
Rate for Payer: Ohana Health Plan Medicaid	$1.34
Rate for Payer: Ohana Health Plan Medicare	$1.34
Rate for Payer: UnitedHealthcare Medicaid	$1.92
Rate for Payer: UnitedHealthcare Medicare	$1.34
Rate for Payer: University Health Alliance Commercial	$2.33

metoprolol 25 mg ER Tab [KMC]

Facility

$4.22

Service Code	NDC 55111046601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$4.09
Rate for Payer: AlohaCare Medicaid	$2.11
Rate for Payer: AlohaCare Medicare	$1.77
Rate for Payer: Cash Price	$2.74
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.88
Rate for Payer: Devoted Health Medicare	$1.77
Rate for Payer: Hawaii Medical Service Association Medicare	$1.77
Rate for Payer: Hawaii Western Management Group Commercial	$4.01
Rate for Payer: Health Management Network Commercial	$3.59
Rate for Payer: Humana Medicare	$1.77
Rate for Payer: Kaiser Permanente Commercial	$3.80
Rate for Payer: Kaiser Permanente Medicaid	$2.15
Rate for Payer: Kaiser Permanente Medicare	$1.77
Rate for Payer: MDX Hawaii PPO	$4.09
Rate for Payer: Ohana Health Plan Medicaid	$1.77
Rate for Payer: Ohana Health Plan Medicare	$1.77
Rate for Payer: UnitedHealthcare Medicaid	$2.53
Rate for Payer: UnitedHealthcare Medicare	$1.77
Rate for Payer: University Health Alliance Commercial	$3.08

Know your out-of-pocket cost for care.

All Charges