Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

metoprolol succ ER 25 mg tablet [HHSC]

Facility

$6.20

Service Code	NDC 60687039001
Hospital Charge Code	2500541
Hospital Revenue Code	250
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$6.01
Rate for Payer: Cash Price	$4.03
Rate for Payer: Health Management Network Commercial	$5.27
Rate for Payer: Kaiser Permanente Commercial	$5.58
Rate for Payer: MDX Hawaii PPO	$6.01

metoprolol succ ER 25 mg tablet [HHSC]

Facility

$6.20

Service Code	NDC 60687039001
Hospital Charge Code	2500541
Hospital Revenue Code	250
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$6.01
Rate for Payer: AlohaCare Medicaid	$3.10
Rate for Payer: AlohaCare Medicare	$3.10
Rate for Payer: Cash Price	$4.03
Rate for Payer: Devoted Health Medicare	$3.41
Rate for Payer: Hawaii Medical Service Association Medicare	$3.10
Rate for Payer: Hawaii Western Management Group Commercial	$5.89
Rate for Payer: Health Management Network Commercial	$5.27
Rate for Payer: Humana Medicare	$3.10
Rate for Payer: Kaiser Permanente Commercial	$5.58
Rate for Payer: Kaiser Permanente Medicaid	$3.16
Rate for Payer: Kaiser Permanente Medicare	$3.10
Rate for Payer: MDX Hawaii PPO	$6.01
Rate for Payer: Ohana Health Plan Medicaid	$3.10
Rate for Payer: Ohana Health Plan Medicare	$3.10
Rate for Payer: UnitedHealthcare Medicaid	$3.72
Rate for Payer: UnitedHealthcare Medicare	$3.10
Rate for Payer: University Health Alliance Commercial	$4.52

metoprolol succ ER 25 mg tablet [HHSC]

Facility

$6.20

Service Code	NDC 68084065901
Hospital Charge Code	2500541
Hospital Revenue Code	250
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$6.01
Rate for Payer: Cash Price	$4.03
Rate for Payer: Health Management Network Commercial	$5.27
Rate for Payer: Kaiser Permanente Commercial	$5.58
Rate for Payer: MDX Hawaii PPO	$6.01

metoprolol succ ER 50 mg tablet [HHSC]

Facility

$6.20

Service Code	NDC 60687040201
Hospital Charge Code	2500543
Hospital Revenue Code	250
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$6.01
Rate for Payer: AlohaCare Medicaid	$3.10
Rate for Payer: AlohaCare Medicare	$3.10
Rate for Payer: Cash Price	$4.03
Rate for Payer: Devoted Health Medicare	$3.41
Rate for Payer: Hawaii Medical Service Association Medicare	$3.10
Rate for Payer: Hawaii Western Management Group Commercial	$5.89
Rate for Payer: Health Management Network Commercial	$5.27
Rate for Payer: Humana Medicare	$3.10
Rate for Payer: Kaiser Permanente Commercial	$5.58
Rate for Payer: Kaiser Permanente Medicaid	$3.16
Rate for Payer: Kaiser Permanente Medicare	$3.10
Rate for Payer: MDX Hawaii PPO	$6.01
Rate for Payer: Ohana Health Plan Medicaid	$3.10
Rate for Payer: Ohana Health Plan Medicare	$3.10
Rate for Payer: UnitedHealthcare Medicaid	$3.72
Rate for Payer: UnitedHealthcare Medicare	$3.10
Rate for Payer: University Health Alliance Commercial	$4.52

metoprolol succ ER 50 mg tablet [HHSC]

Facility

$6.20

Service Code	NDC 60687040201
Hospital Charge Code	2500543
Hospital Revenue Code	250
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$6.01
Rate for Payer: Cash Price	$4.03
Rate for Payer: Health Management Network Commercial	$5.27
Rate for Payer: Kaiser Permanente Commercial	$5.58
Rate for Payer: MDX Hawaii PPO	$6.01

metoprolol succ ER 50 mg tablet [HHSC]

Facility

$6.20

Service Code	NDC 68084066601
Hospital Charge Code	2500543
Hospital Revenue Code	250
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$6.01
Rate for Payer: Cash Price	$4.03
Rate for Payer: Health Management Network Commercial	$5.27
Rate for Payer: Kaiser Permanente Commercial	$5.58
Rate for Payer: MDX Hawaii PPO	$6.01

metoprolol succ ER 50 mg tablet [HHSC]

Facility

$6.20

Service Code	NDC 68084066601
Hospital Charge Code	2500543
Hospital Revenue Code	250
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$6.01
Rate for Payer: AlohaCare Medicaid	$3.10
Rate for Payer: AlohaCare Medicare	$3.10
Rate for Payer: Cash Price	$4.03
Rate for Payer: Devoted Health Medicare	$3.41
Rate for Payer: Hawaii Medical Service Association Medicare	$3.10
Rate for Payer: Hawaii Western Management Group Commercial	$5.89
Rate for Payer: Health Management Network Commercial	$5.27
Rate for Payer: Humana Medicare	$3.10
Rate for Payer: Kaiser Permanente Commercial	$5.58
Rate for Payer: Kaiser Permanente Medicaid	$3.16
Rate for Payer: Kaiser Permanente Medicare	$3.10
Rate for Payer: MDX Hawaii PPO	$6.01
Rate for Payer: Ohana Health Plan Medicaid	$3.10
Rate for Payer: Ohana Health Plan Medicare	$3.10
Rate for Payer: UnitedHealthcare Medicaid	$3.72
Rate for Payer: UnitedHealthcare Medicare	$3.10
Rate for Payer: University Health Alliance Commercial	$4.52

metoprolol tart 25 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 62584026501
Hospital Charge Code	2500542
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 tart 25 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 51079025520
Hospital Charge Code	2500542
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 tart 25 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 51079025520
Hospital Charge Code	2500542
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

metoprolol tart 25 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 57664050652
Hospital Charge Code	2500542
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

metoprolol tart 25 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 62584026501
Hospital Charge Code	2500542
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

metoprolol tart 25 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 57664050652
Hospital Charge Code	2500542
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 tart 50 mg tablet [HHSC]

Facility

$3.18

Service Code	NDC 51079080120
Hospital Charge Code	2500544
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$3.08
Rate for Payer: Cash Price	$2.07
Rate for Payer: Health Management Network Commercial	$2.70
Rate for Payer: Kaiser Permanente Commercial	$2.86
Rate for Payer: MDX Hawaii PPO	$3.08

metoprolol tart 50 mg tablet [HHSC]

Facility

$3.18

Service Code	NDC 51079080120
Hospital Charge Code	2500544
Hospital Revenue Code	250
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$3.08
Rate for Payer: AlohaCare Medicaid	$1.59
Rate for Payer: AlohaCare Medicare	$1.59
Rate for Payer: Cash Price	$2.07
Rate for Payer: Devoted Health Medicare	$1.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1.59
Rate for Payer: Hawaii Western Management Group Commercial	$3.02
Rate for Payer: Health Management Network Commercial	$2.70
Rate for Payer: Humana Medicare	$1.59
Rate for Payer: Kaiser Permanente Commercial	$2.86
Rate for Payer: Kaiser Permanente Medicaid	$1.62
Rate for Payer: Kaiser Permanente Medicare	$1.59
Rate for Payer: MDX Hawaii PPO	$3.08
Rate for Payer: Ohana Health Plan Medicaid	$1.59
Rate for Payer: Ohana Health Plan Medicare	$1.59
Rate for Payer: UnitedHealthcare Medicaid	$1.91
Rate for Payer: UnitedHealthcare Medicare	$1.59
Rate for Payer: University Health Alliance Commercial	$2.32

metoprolol tart 50 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 62584026601
Hospital Charge Code	2500544
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 tart 50 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 62584026601
Hospital Charge Code	2500544
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

metroNIDAZOLE 500 mg tablet [HHSC]

Facility

$5.12

Service Code	NDC 60687055001
Hospital Charge Code	2500546
Hospital Revenue Code	250
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$4.97
Rate for Payer: AlohaCare Medicaid	$2.56
Rate for Payer: AlohaCare Medicare	$2.56
Rate for Payer: Cash Price	$3.33
Rate for Payer: Devoted Health Medicare	$2.82
Rate for Payer: Hawaii Medical Service Association Medicare	$2.56
Rate for Payer: Hawaii Western Management Group Commercial	$4.86
Rate for Payer: Health Management Network Commercial	$4.35
Rate for Payer: Humana Medicare	$2.56
Rate for Payer: Kaiser Permanente Commercial	$4.61
Rate for Payer: Kaiser Permanente Medicaid	$2.61
Rate for Payer: Kaiser Permanente Medicare	$2.56
Rate for Payer: MDX Hawaii PPO	$4.97
Rate for Payer: Ohana Health Plan Medicaid	$2.56
Rate for Payer: Ohana Health Plan Medicare	$2.56
Rate for Payer: UnitedHealthcare Medicaid	$3.07
Rate for Payer: UnitedHealthcare Medicare	$2.56
Rate for Payer: University Health Alliance Commercial	$3.73

metroNIDAZOLE 500 mg tablet [HHSC]

Facility

$5.12

Service Code	NDC 68084096601
Hospital Charge Code	2500546
Hospital Revenue Code	250
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$4.97
Rate for Payer: AlohaCare Medicaid	$2.56
Rate for Payer: AlohaCare Medicare	$2.56
Rate for Payer: Cash Price	$3.33
Rate for Payer: Devoted Health Medicare	$2.82
Rate for Payer: Hawaii Medical Service Association Medicare	$2.56
Rate for Payer: Hawaii Western Management Group Commercial	$4.86
Rate for Payer: Health Management Network Commercial	$4.35
Rate for Payer: Humana Medicare	$2.56
Rate for Payer: Kaiser Permanente Commercial	$4.61
Rate for Payer: Kaiser Permanente Medicaid	$2.61
Rate for Payer: Kaiser Permanente Medicare	$2.56
Rate for Payer: MDX Hawaii PPO	$4.97
Rate for Payer: Ohana Health Plan Medicaid	$2.56
Rate for Payer: Ohana Health Plan Medicare	$2.56
Rate for Payer: UnitedHealthcare Medicaid	$3.07
Rate for Payer: UnitedHealthcare Medicare	$2.56
Rate for Payer: University Health Alliance Commercial	$3.73

metroNIDAZOLE 500 mg tablet [HHSC]

Facility

$5.12

Service Code	NDC 68084096601
Hospital Charge Code	2500546
Hospital Revenue Code	250
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$4.97
Rate for Payer: Cash Price	$3.33
Rate for Payer: Health Management Network Commercial	$4.35
Rate for Payer: Kaiser Permanente Commercial	$4.61
Rate for Payer: MDX Hawaii PPO	$4.97

metroNIDAZOLE 500 mg tablet [HHSC]

Facility

$5.12

Service Code	NDC 60687042401
Hospital Charge Code	2500546
Hospital Revenue Code	250
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$4.97
Rate for Payer: Cash Price	$3.33
Rate for Payer: Health Management Network Commercial	$4.35
Rate for Payer: Kaiser Permanente Commercial	$4.61
Rate for Payer: MDX Hawaii PPO	$4.97

metroNIDAZOLE 500 mg tablet [HHSC]

Facility

$5.12

Service Code	NDC 60687055001
Hospital Charge Code	2500546
Hospital Revenue Code	250
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$4.97
Rate for Payer: Cash Price	$3.33
Rate for Payer: Health Management Network Commercial	$4.35
Rate for Payer: Kaiser Permanente Commercial	$4.61
Rate for Payer: MDX Hawaii PPO	$4.97

metroNIDAZOLE 500 mg tablet [HHSC]

Facility

$5.12

Service Code	NDC 60687042401
Hospital Charge Code	2500546
Hospital Revenue Code	250
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$4.97
Rate for Payer: AlohaCare Medicaid	$2.56
Rate for Payer: AlohaCare Medicare	$2.56
Rate for Payer: Cash Price	$3.33
Rate for Payer: Devoted Health Medicare	$2.82
Rate for Payer: Hawaii Medical Service Association Medicare	$2.56
Rate for Payer: Hawaii Western Management Group Commercial	$4.86
Rate for Payer: Health Management Network Commercial	$4.35
Rate for Payer: Humana Medicare	$2.56
Rate for Payer: Kaiser Permanente Commercial	$4.61
Rate for Payer: Kaiser Permanente Medicaid	$2.61
Rate for Payer: Kaiser Permanente Medicare	$2.56
Rate for Payer: MDX Hawaii PPO	$4.97
Rate for Payer: Ohana Health Plan Medicaid	$2.56
Rate for Payer: Ohana Health Plan Medicare	$2.56
Rate for Payer: UnitedHealthcare Medicaid	$3.07
Rate for Payer: UnitedHealthcare Medicare	$2.56
Rate for Payer: University Health Alliance Commercial	$3.73

metroNIDAZOLE-ns 500 mg/100 ml premix [HHSC]

Facility

$12.81

Service Code	NDC 00409015224
Hospital Charge Code	2500547
Hospital Revenue Code	250
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$12.43
Rate for Payer: AlohaCare Medicaid	$6.41
Rate for Payer: AlohaCare Medicare	$6.41
Rate for Payer: Cash Price	$8.33
Rate for Payer: Devoted Health Medicare	$7.05
Rate for Payer: Hawaii Medical Service Association Medicare	$6.41
Rate for Payer: Hawaii Western Management Group Commercial	$12.17
Rate for Payer: Health Management Network Commercial	$10.89
Rate for Payer: Humana Medicare	$6.41
Rate for Payer: Kaiser Permanente Commercial	$11.53
Rate for Payer: Kaiser Permanente Medicaid	$6.53
Rate for Payer: Kaiser Permanente Medicare	$6.41
Rate for Payer: MDX Hawaii PPO	$12.43
Rate for Payer: Ohana Health Plan Medicaid	$6.41
Rate for Payer: Ohana Health Plan Medicare	$6.41
Rate for Payer: UnitedHealthcare Medicaid	$7.69
Rate for Payer: UnitedHealthcare Medicare	$6.41
Rate for Payer: University Health Alliance Commercial	$9.34

metroNIDAZOLE-ns 500 mg/100 ml premix [HHSC]

Facility

$12.14

Service Code	NDC 00409781110
Hospital Charge Code	2500547
Hospital Revenue Code	250
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$11.78
Rate for Payer: Cash Price	$7.89
Rate for Payer: Health Management Network Commercial	$10.32
Rate for Payer: Kaiser Permanente Commercial	$10.93
Rate for Payer: MDX Hawaii PPO	$11.78

Know your out-of-pocket cost for care.

All Charges