Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

metoprolol 25 mg ER Tab [KMC]

Facility

$4.22

Service Code	NDC 55111046601
Hospital Revenue Code	250
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$4.09
Rate for Payer: Cash Price	$2.74
Rate for Payer: Health Management Network Commercial	$3.59
Rate for Payer: Kaiser Permanente Commercial	$3.80
Rate for Payer: MDX Hawaii PPO	$4.09

metoprolol 25 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 65862006201
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

metoprolol 25 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 65862006201
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

metoprolol 50 mg ER tab [KMC]

Facility

$5.04

Service Code	NDC 72516003101
Hospital Revenue Code	250
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$4.89
Rate for Payer: Cash Price	$3.28
Rate for Payer: Health Management Network Commercial	$4.28
Rate for Payer: Kaiser Permanente Commercial	$4.54
Rate for Payer: MDX Hawaii PPO	$4.89

metoprolol 50 mg ER tab [KMC]

Facility

$5.04

Service Code	NDC 72516003101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$4.89
Rate for Payer: AlohaCare Medicaid	$2.52
Rate for Payer: AlohaCare Medicare	$2.12
Rate for Payer: Cash Price	$3.28
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.64
Rate for Payer: Devoted Health Medicare	$2.12
Rate for Payer: Hawaii Medical Service Association Medicare	$2.12
Rate for Payer: Hawaii Western Management Group Commercial	$4.79
Rate for Payer: Health Management Network Commercial	$4.28
Rate for Payer: Humana Medicare	$2.12
Rate for Payer: Kaiser Permanente Commercial	$4.54
Rate for Payer: Kaiser Permanente Medicaid	$2.57
Rate for Payer: Kaiser Permanente Medicare	$2.12
Rate for Payer: MDX Hawaii PPO	$4.89
Rate for Payer: Ohana Health Plan Medicaid	$2.12
Rate for Payer: Ohana Health Plan Medicare	$2.12
Rate for Payer: UnitedHealthcare Medicaid	$3.02
Rate for Payer: UnitedHealthcare Medicare	$2.12
Rate for Payer: University Health Alliance Commercial	$3.67

metoprolol 50 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 51079080120
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

metoprolol 50 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 51079080120
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

metoprolol 5 mg / 5 mL Inj Sol [KMC]

Facility

$0.94

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.91
Rate for Payer: AlohaCare Medicaid	$0.47
Rate for Payer: AlohaCare Medicare	$0.39
Rate for Payer: Cash Price	$0.61
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.86
Rate for Payer: Devoted Health Medicare	$0.39
Rate for Payer: Hawaii Medical Service Association Medicare	$0.39
Rate for Payer: Hawaii Western Management Group Commercial	$0.89
Rate for Payer: Health Management Network Commercial	$0.80
Rate for Payer: Humana Medicare	$0.39
Rate for Payer: Kaiser Permanente Commercial	$0.85
Rate for Payer: Kaiser Permanente Medicaid	$0.48
Rate for Payer: Kaiser Permanente Medicare	$0.39
Rate for Payer: MDX Hawaii PPO	$0.91
Rate for Payer: Ohana Health Plan Medicaid	$0.39
Rate for Payer: Ohana Health Plan Medicare	$0.39
Rate for Payer: UnitedHealthcare Medicaid	$0.56
Rate for Payer: UnitedHealthcare Medicare	$0.39
Rate for Payer: University Health Alliance Commercial	$0.69

metoprolol 5 mg / 5 mL Inj Sol [KMC]

Facility

$0.94

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.91
Rate for Payer: Cash Price	$0.61
Rate for Payer: Health Management Network Commercial	$0.80
Rate for Payer: Kaiser Permanente Commercial	$0.85
Rate for Payer: MDX Hawaii PPO	$0.91

metroNIDAZOLE 500 mg/100 mL IV Sol [KMC]

Facility

$0.10

Service Code	HCPCS J1836
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.10
Rate for Payer: AlohaCare Medicaid	$0.05
Rate for Payer: AlohaCare Medicare	$0.04
Rate for Payer: Cash Price	$0.06
Rate for Payer: Cash Price	$0.06
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.09
Rate for Payer: Devoted Health Medicare	$0.04
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.03
Rate for Payer: Hawaii Medical Service Association Medicare	$0.04
Rate for Payer: Hawaii Western Management Group Commercial	$0.10
Rate for Payer: Health Management Network Commercial	$0.09
Rate for Payer: Humana Medicare	$0.04
Rate for Payer: Kaiser Permanente Commercial	$0.09
Rate for Payer: Kaiser Permanente Medicaid	$0.05
Rate for Payer: Kaiser Permanente Medicare	$0.04
Rate for Payer: MDX Hawaii PPO	$0.10
Rate for Payer: Ohana Health Plan Medicaid	$0.04
Rate for Payer: Ohana Health Plan Medicare	$0.04
Rate for Payer: UnitedHealthcare Medicaid	$0.06
Rate for Payer: UnitedHealthcare Medicare	$0.04
Rate for Payer: University Health Alliance Commercial	$0.07

metroNIDAZOLE 500 mg/100 mL IV Sol [KMC]

Facility

$0.10

Service Code	HCPCS J1836
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.06
Rate for Payer: Health Management Network Commercial	$0.09
Rate for Payer: Kaiser Permanente Commercial	$0.09
Rate for Payer: MDX Hawaii PPO	$0.10

metroNIDAZOLE 500 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 16571066401
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

metroNIDAZOLE 500 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 16571066401
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

METZENBAUM SCISSORS CURVED 5.5"

Facility

$2.00

Hospital Charge Code	8571
Hospital Revenue Code	270
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.30
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

METZENBAUM SCISSORS CURVED 5.5"

Facility

$2.00

Hospital Charge Code	8571
Hospital Revenue Code	270
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$0.84
Rate for Payer: Cash Price	$1.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.84
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.84
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$0.84
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$0.84
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$0.84
Rate for Payer: Ohana Health Plan Medicare	$0.84
Rate for Payer: UnitedHealthcare Medicare	$0.84
Rate for Payer: University Health Alliance Commercial	$1.46

METZENBAUM SCISSORS STRAIGHT 5.5"

Facility

$177.00

Hospital Charge Code	8572
Hospital Revenue Code	270
Min. Negotiated Rate	$74.34
Max. Negotiated Rate	$171.69
Rate for Payer: AlohaCare Medicaid	$88.50
Rate for Payer: AlohaCare Medicare	$74.34
Rate for Payer: Cash Price	$115.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$162.84
Rate for Payer: Devoted Health Medicare	$74.34
Rate for Payer: Hawaii Medical Service Association Medicare	$74.34
Rate for Payer: Hawaii Western Management Group Commercial	$168.15
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Humana Medicare	$74.34
Rate for Payer: Kaiser Permanente Commercial	$159.30
Rate for Payer: Kaiser Permanente Medicaid	$90.27
Rate for Payer: Kaiser Permanente Medicare	$74.34
Rate for Payer: MDX Hawaii PPO	$171.69
Rate for Payer: Ohana Health Plan Medicaid	$74.34
Rate for Payer: Ohana Health Plan Medicare	$74.34
Rate for Payer: UnitedHealthcare Medicare	$74.34
Rate for Payer: University Health Alliance Commercial	$129.02

METZENBAUM SCISSORS STRAIGHT 5.5"

Facility

$177.00

Hospital Charge Code	8572
Hospital Revenue Code	270
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$115.05
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Kaiser Permanente Commercial	$159.30
Rate for Payer: MDX Hawaii PPO	$171.69

METZEN STERILE SCS 7" CVD

Facility

$3.00

Hospital Charge Code	8549
Hospital Revenue Code	270
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

METZEN STERILE SCS 7" CVD

Facility

$3.00

Hospital Charge Code	8549
Hospital Revenue Code	270
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 Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

mexiletine 150 mg Cap

Facility

$10.14

Service Code	NDC 00093873901
Hospital Revenue Code	250
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$9.84
Rate for Payer: AlohaCare Medicaid	$5.07
Rate for Payer: AlohaCare Medicare	$4.26
Rate for Payer: Cash Price	$6.59
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$9.33
Rate for Payer: Devoted Health Medicare	$4.26
Rate for Payer: Hawaii Medical Service Association Medicare	$4.26
Rate for Payer: Hawaii Western Management Group Commercial	$9.63
Rate for Payer: Health Management Network Commercial	$8.62
Rate for Payer: Humana Medicare	$4.26
Rate for Payer: Kaiser Permanente Commercial	$9.13
Rate for Payer: Kaiser Permanente Medicaid	$5.17
Rate for Payer: Kaiser Permanente Medicare	$4.26
Rate for Payer: MDX Hawaii PPO	$9.84
Rate for Payer: Ohana Health Plan Medicaid	$4.26
Rate for Payer: Ohana Health Plan Medicare	$4.26
Rate for Payer: UnitedHealthcare Medicaid	$6.08
Rate for Payer: UnitedHealthcare Medicare	$4.26
Rate for Payer: University Health Alliance Commercial	$7.39

mexiletine 150 mg Cap

Facility

$10.14

Service Code	NDC 00093873901
Hospital Revenue Code	250
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$9.84
Rate for Payer: Cash Price	$6.59
Rate for Payer: Health Management Network Commercial	$8.62
Rate for Payer: Kaiser Permanente Commercial	$9.13
Rate for Payer: MDX Hawaii PPO	$9.84

micafungin 100 mg REC [KMC]

Facility

$897.60

Service Code	HCPCS J2248
Hospital Revenue Code	636
Min. Negotiated Rate	$762.96
Max. Negotiated Rate	$870.67
Rate for Payer: Cash Price	$583.44
Rate for Payer: Health Management Network Commercial	$762.96
Rate for Payer: Kaiser Permanente Commercial	$807.84
Rate for Payer: MDX Hawaii PPO	$870.67

micafungin 100 mg REC [KMC]

Facility

$897.60

Service Code	HCPCS J2248
Hospital Revenue Code	636
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$870.67
Rate for Payer: AlohaCare Medicaid	$448.80
Rate for Payer: AlohaCare Medicare	$376.99
Rate for Payer: Cash Price	$583.44
Rate for Payer: Cash Price	$583.44
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$825.79
Rate for Payer: Devoted Health Medicare	$376.99
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.31
Rate for Payer: Hawaii Medical Service Association Medicare	$376.99
Rate for Payer: Hawaii Western Management Group Commercial	$852.72
Rate for Payer: Health Management Network Commercial	$762.96
Rate for Payer: Humana Medicare	$376.99
Rate for Payer: Kaiser Permanente Commercial	$807.84
Rate for Payer: Kaiser Permanente Medicaid	$457.78
Rate for Payer: Kaiser Permanente Medicare	$376.99
Rate for Payer: MDX Hawaii PPO	$870.67
Rate for Payer: Ohana Health Plan Medicaid	$376.99
Rate for Payer: Ohana Health Plan Medicare	$376.99
Rate for Payer: UnitedHealthcare Medicaid	$538.56
Rate for Payer: UnitedHealthcare Medicare	$376.99
Rate for Payer: University Health Alliance Commercial	$654.26

Miconazole 2% cream [KMC]

Facility

$0.29

Service Code	NDC 11701004514
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.28
Rate for Payer: Cash Price	$0.19
Rate for Payer: Health Management Network Commercial	$0.25
Rate for Payer: Kaiser Permanente Commercial	$0.26
Rate for Payer: MDX Hawaii PPO	$0.28

Miconazole 2% cream [KMC]

Facility

$0.29

Service Code	NDC 11701004514
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.28
Rate for Payer: AlohaCare Medicaid	$0.15
Rate for Payer: AlohaCare Medicare	$0.12
Rate for Payer: Cash Price	$0.19
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.27
Rate for Payer: Devoted Health Medicare	$0.12
Rate for Payer: Hawaii Medical Service Association Medicare	$0.12
Rate for Payer: Hawaii Western Management Group Commercial	$0.28
Rate for Payer: Health Management Network Commercial	$0.25
Rate for Payer: Humana Medicare	$0.12
Rate for Payer: Kaiser Permanente Commercial	$0.26
Rate for Payer: Kaiser Permanente Medicaid	$0.15
Rate for Payer: Kaiser Permanente Medicare	$0.12
Rate for Payer: MDX Hawaii PPO	$0.28
Rate for Payer: Ohana Health Plan Medicaid	$0.12
Rate for Payer: Ohana Health Plan Medicare	$0.12
Rate for Payer: UnitedHealthcare Medicaid	$0.17
Rate for Payer: UnitedHealthcare Medicare	$0.12
Rate for Payer: University Health Alliance Commercial	$0.21

Know your out-of-pocket cost for care.

All Charges