Kohala Hospital

All Charges

Charge

Type

Setting

Price

MEGESTROL 400 MG/10 ML (10 ML) PO SUSP

Facility

$44.38

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$37.72
Max. Negotiated Rate	$43.05
Rate for Payer: Cash Price	$28.85
Rate for Payer: Cash Price	$18.02
Rate for Payer: Health Management Network Commercial	$23.56
Rate for Payer: Health Management Network Commercial	$37.72
Rate for Payer: Kaiser Permanente Commercial	$24.95
Rate for Payer: Kaiser Permanente Commercial	$39.94
Rate for Payer: MDX Hawaii PPO	$43.05
Rate for Payer: MDX Hawaii PPO	$26.89

MEGESTROL 40 MG PO TABLET

Facility

$6.79

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$6.72
Rate for Payer: AlohaCare Medicaid	$3.40
Rate for Payer: AlohaCare Medicare	$6.11
Rate for Payer: Cash Price	$4.41
Rate for Payer: Devoted Health Medicare	$6.72
Rate for Payer: Hawaii Medical Service Association Medicare	$6.11
Rate for Payer: Hawaii Western Management Group Commercial	$6.45
Rate for Payer: Health Management Network Commercial	$5.77
Rate for Payer: Humana Medicare	$6.11
Rate for Payer: Kaiser Permanente Commercial	$6.11
Rate for Payer: Kaiser Permanente Medicaid	$3.46
Rate for Payer: Kaiser Permanente Medicare	$6.11
Rate for Payer: MDX Hawaii PPO	$6.59
Rate for Payer: Ohana Health Plan Medicaid	$6.11
Rate for Payer: Ohana Health Plan Medicare	$6.11
Rate for Payer: UnitedHealthcare Medicare	$6.11
Rate for Payer: University Health Alliance Commercial	$4.95

MEGESTROL 40 MG PO TABLET

Facility

$6.79

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$6.59
Rate for Payer: Cash Price	$4.41
Rate for Payer: Health Management Network Commercial	$5.77
Rate for Payer: Kaiser Permanente Commercial	$6.11
Rate for Payer: MDX Hawaii PPO	$6.59

MELATONIN 3 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16

MELATONIN 3 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.19
Rate for Payer: AlohaCare Medicaid	$0.60
Rate for Payer: AlohaCare Medicare	$1.08
Rate for Payer: Cash Price	$0.78
Rate for Payer: Devoted Health Medicare	$1.19
Rate for Payer: Hawaii Medical Service Association Medicare	$1.08
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Humana Medicare	$1.08
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicare	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: Ohana Health Plan Medicaid	$1.08
Rate for Payer: Ohana Health Plan Medicare	$1.08
Rate for Payer: UnitedHealthcare Medicare	$1.08
Rate for Payer: University Health Alliance Commercial	$0.87

MEMANTINE 10 MG PO TABLET

Facility

$4.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$4.29
Rate for Payer: Cash Price	$2.87
Rate for Payer: Health Management Network Commercial	$3.76
Rate for Payer: Kaiser Permanente Commercial	$3.98
Rate for Payer: MDX Hawaii PPO	$4.29

MEMANTINE 10 MG PO TABLET

Facility

$4.42

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$4.38
Rate for Payer: AlohaCare Medicaid	$2.21
Rate for Payer: AlohaCare Medicare	$3.98
Rate for Payer: Cash Price	$2.87
Rate for Payer: Devoted Health Medicare	$4.38
Rate for Payer: Hawaii Medical Service Association Medicare	$3.98
Rate for Payer: Hawaii Western Management Group Commercial	$4.20
Rate for Payer: Health Management Network Commercial	$3.76
Rate for Payer: Humana Medicare	$3.98
Rate for Payer: Kaiser Permanente Commercial	$3.98
Rate for Payer: Kaiser Permanente Medicaid	$2.25
Rate for Payer: Kaiser Permanente Medicare	$3.98
Rate for Payer: MDX Hawaii PPO	$4.29
Rate for Payer: Ohana Health Plan Medicaid	$3.98
Rate for Payer: Ohana Health Plan Medicare	$3.98
Rate for Payer: UnitedHealthcare Medicare	$3.98
Rate for Payer: University Health Alliance Commercial	$3.22

MEMANTINE 5 MG PO TABLET

Facility

$4.42

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$4.38
Rate for Payer: AlohaCare Medicaid	$2.21
Rate for Payer: AlohaCare Medicare	$3.98
Rate for Payer: Cash Price	$2.87
Rate for Payer: Devoted Health Medicare	$4.38
Rate for Payer: Hawaii Medical Service Association Medicare	$3.98
Rate for Payer: Hawaii Western Management Group Commercial	$4.20
Rate for Payer: Health Management Network Commercial	$3.76
Rate for Payer: Humana Medicare	$3.98
Rate for Payer: Kaiser Permanente Commercial	$3.98
Rate for Payer: Kaiser Permanente Medicaid	$2.25
Rate for Payer: Kaiser Permanente Medicare	$3.98
Rate for Payer: MDX Hawaii PPO	$4.29
Rate for Payer: Ohana Health Plan Medicaid	$3.98
Rate for Payer: Ohana Health Plan Medicare	$3.98
Rate for Payer: UnitedHealthcare Medicare	$3.98
Rate for Payer: University Health Alliance Commercial	$3.22

MEMANTINE 5 MG PO TABLET

Facility

$4.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$4.29
Rate for Payer: Cash Price	$2.87
Rate for Payer: Health Management Network Commercial	$3.76
Rate for Payer: Kaiser Permanente Commercial	$3.98
Rate for Payer: MDX Hawaii PPO	$4.29

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC

Facility

$11,993.21

Service Code	MSDRG 760
Min. Negotiated Rate	$11,993.21
Max. Negotiated Rate	$11,993.21
Rate for Payer: Hawaii Medical Service Association Commercial	$11,993.21

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$11,993.21

Service Code	MSDRG 761
Min. Negotiated Rate	$11,993.21
Max. Negotiated Rate	$11,993.21
Rate for Payer: Hawaii Medical Service Association Commercial	$11,993.21

MEPERIDINE (PF) 25 MG/ML INJ SOLN

Facility

$14.00

Service Code	HCPCS J2175
Hospital Revenue Code	636
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$15.69
Rate for Payer: AlohaCare Medicaid	$7.00
Rate for Payer: AlohaCare Medicare	$12.60
Rate for Payer: Cash Price	$9.10
Rate for Payer: Cash Price	$9.10
Rate for Payer: Devoted Health Medicare	$13.86
Rate for Payer: Hawaii Medical Service Association ABD	$15.69
Rate for Payer: Hawaii Medical Service Association Medicare	$12.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.69
Rate for Payer: Hawaii Western Management Group Commercial	$13.30
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Humana Medicare	$12.60
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: Kaiser Permanente Medicaid	$7.14
Rate for Payer: Kaiser Permanente Medicare	$12.60
Rate for Payer: MDX Hawaii PPO	$13.58
Rate for Payer: Ohana Health Plan Medicaid	$12.60
Rate for Payer: Ohana Health Plan Medicare	$12.60
Rate for Payer: UnitedHealthcare Medicaid	$8.40
Rate for Payer: UnitedHealthcare Medicare	$12.60
Rate for Payer: University Health Alliance Commercial	$10.20

MEPERIDINE (PF) 25 MG/ML INJ SOLN

Facility

$14.00

Service Code	HCPCS J2175
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$9.10
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: MDX Hawaii PPO	$13.58

MEROPENEM-0.9% SODIUM CHLORIDE 1 GRAM/50 ML IV IVPB

Facility

$141.83

Service Code	HCPCS J2184
Hospital Revenue Code	250
Min. Negotiated Rate	$120.56
Max. Negotiated Rate	$137.58
Rate for Payer: Cash Price	$92.19
Rate for Payer: Health Management Network Commercial	$120.56
Rate for Payer: Kaiser Permanente Commercial	$127.65
Rate for Payer: MDX Hawaii PPO	$137.58

MEROPENEM-0.9% SODIUM CHLORIDE 1 GRAM/50 ML IV IVPB

Facility

$141.83

Service Code	HCPCS J2184
Hospital Revenue Code	636
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$140.41
Rate for Payer: AlohaCare Medicaid	$70.92
Rate for Payer: AlohaCare Medicare	$127.65
Rate for Payer: Cash Price	$92.19
Rate for Payer: Cash Price	$92.19
Rate for Payer: Devoted Health Medicare	$140.41
Rate for Payer: Hawaii Medical Service Association ABD	$2.08
Rate for Payer: Hawaii Medical Service Association Medicare	$127.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.08
Rate for Payer: Hawaii Western Management Group Commercial	$134.74
Rate for Payer: Health Management Network Commercial	$120.56
Rate for Payer: Humana Medicare	$127.65
Rate for Payer: Kaiser Permanente Commercial	$127.65
Rate for Payer: Kaiser Permanente Medicaid	$72.33
Rate for Payer: Kaiser Permanente Medicare	$127.65
Rate for Payer: MDX Hawaii PPO	$137.58
Rate for Payer: Ohana Health Plan Medicaid	$127.65
Rate for Payer: Ohana Health Plan Medicare	$127.65
Rate for Payer: UnitedHealthcare Medicaid	$85.10
Rate for Payer: UnitedHealthcare Medicare	$127.65
Rate for Payer: University Health Alliance Commercial	$103.38

MEROPENEM 1 GRAM IV RECON.SOLN.

Facility

$32.57

Service Code	HCPCS J2185
Hospital Revenue Code	636
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$32.24
Rate for Payer: AlohaCare Medicaid	$16.29
Rate for Payer: AlohaCare Medicare	$29.31
Rate for Payer: Cash Price	$21.17
Rate for Payer: Cash Price	$21.17
Rate for Payer: Devoted Health Medicare	$32.24
Rate for Payer: Hawaii Medical Service Association ABD	$0.44
Rate for Payer: Hawaii Medical Service Association Medicare	$29.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.44
Rate for Payer: Hawaii Western Management Group Commercial	$30.94
Rate for Payer: Health Management Network Commercial	$27.68
Rate for Payer: Humana Medicare	$29.31
Rate for Payer: Kaiser Permanente Commercial	$29.31
Rate for Payer: Kaiser Permanente Medicaid	$16.61
Rate for Payer: Kaiser Permanente Medicare	$29.31
Rate for Payer: MDX Hawaii PPO	$31.59
Rate for Payer: Ohana Health Plan Medicaid	$29.31
Rate for Payer: Ohana Health Plan Medicare	$29.31
Rate for Payer: UnitedHealthcare Medicaid	$19.54
Rate for Payer: UnitedHealthcare Medicare	$29.31
Rate for Payer: University Health Alliance Commercial	$23.74

MEROPENEM 1 GRAM IV RECON.SOLN.

Facility

$32.57

Service Code	HCPCS J2185
Hospital Revenue Code	250
Min. Negotiated Rate	$27.68
Max. Negotiated Rate	$31.59
Rate for Payer: Cash Price	$21.17
Rate for Payer: Health Management Network Commercial	$27.68
Rate for Payer: Kaiser Permanente Commercial	$29.31
Rate for Payer: MDX Hawaii PPO	$31.59

MESALAMINE 400 MG PO CDTI

Facility

$24.42

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$12.21
Max. Negotiated Rate	$24.18
Rate for Payer: AlohaCare Medicaid	$12.21
Rate for Payer: AlohaCare Medicare	$21.98
Rate for Payer: Cash Price	$15.87
Rate for Payer: Devoted Health Medicare	$24.18
Rate for Payer: Hawaii Medical Service Association Medicare	$21.98
Rate for Payer: Hawaii Western Management Group Commercial	$23.20
Rate for Payer: Health Management Network Commercial	$20.76
Rate for Payer: Humana Medicare	$21.98
Rate for Payer: Kaiser Permanente Commercial	$21.98
Rate for Payer: Kaiser Permanente Medicaid	$12.45
Rate for Payer: Kaiser Permanente Medicare	$21.98
Rate for Payer: MDX Hawaii PPO	$23.69
Rate for Payer: Ohana Health Plan Medicaid	$21.98
Rate for Payer: Ohana Health Plan Medicare	$21.98
Rate for Payer: UnitedHealthcare Medicare	$21.98
Rate for Payer: University Health Alliance Commercial	$17.80

MESALAMINE 400 MG PO CDTI

Facility

$24.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$20.76
Max. Negotiated Rate	$23.69
Rate for Payer: Cash Price	$15.87
Rate for Payer: Health Management Network Commercial	$20.76
Rate for Payer: Kaiser Permanente Commercial	$21.98
Rate for Payer: MDX Hawaii PPO	$23.69

METFORMIN 500 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.19
Rate for Payer: AlohaCare Medicaid	$0.60
Rate for Payer: AlohaCare Medicaid	$1.94
Rate for Payer: AlohaCare Medicare	$1.08
Rate for Payer: AlohaCare Medicare	$3.48
Rate for Payer: Cash Price	$2.52
Rate for Payer: Cash Price	$0.78
Rate for Payer: Devoted Health Medicare	$1.19
Rate for Payer: Devoted Health Medicare	$3.83
Rate for Payer: Hawaii Medical Service Association Medicare	$3.48
Rate for Payer: Hawaii Medical Service Association Medicare	$1.08
Rate for Payer: Hawaii Western Management Group Commercial	$3.68
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$3.29
Rate for Payer: Humana Medicare	$3.48
Rate for Payer: Humana Medicare	$1.08
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Commercial	$3.48
Rate for Payer: Kaiser Permanente Medicaid	$1.97
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicare	$3.48
Rate for Payer: Kaiser Permanente Medicare	$1.08
Rate for Payer: MDX Hawaii PPO	$3.75
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: Ohana Health Plan Medicaid	$1.08
Rate for Payer: Ohana Health Plan Medicaid	$3.48
Rate for Payer: Ohana Health Plan Medicare	$1.08
Rate for Payer: Ohana Health Plan Medicare	$3.48
Rate for Payer: UnitedHealthcare Medicare	$1.08
Rate for Payer: UnitedHealthcare Medicare	$3.48
Rate for Payer: University Health Alliance Commercial	$2.82
Rate for Payer: University Health Alliance Commercial	$0.87

METFORMIN 500 MG PO TABLET

Facility

$3.87

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$3.75
Rate for Payer: Cash Price	$2.52
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$3.29
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$3.48
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$3.75

METFORMIN 850 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.19
Rate for Payer: AlohaCare Medicaid	$0.60
Rate for Payer: AlohaCare Medicaid	$3.33
Rate for Payer: AlohaCare Medicare	$1.08
Rate for Payer: AlohaCare Medicare	$5.99
Rate for Payer: Cash Price	$4.32
Rate for Payer: Cash Price	$0.78
Rate for Payer: Devoted Health Medicare	$1.19
Rate for Payer: Devoted Health Medicare	$6.58
Rate for Payer: Hawaii Medical Service Association Medicare	$5.99
Rate for Payer: Hawaii Medical Service Association Medicare	$1.08
Rate for Payer: Hawaii Western Management Group Commercial	$6.32
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$5.65
Rate for Payer: Humana Medicare	$5.99
Rate for Payer: Humana Medicare	$1.08
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Commercial	$5.99
Rate for Payer: Kaiser Permanente Medicaid	$3.39
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicare	$5.99
Rate for Payer: Kaiser Permanente Medicare	$1.08
Rate for Payer: MDX Hawaii PPO	$6.45
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: Ohana Health Plan Medicaid	$1.08
Rate for Payer: Ohana Health Plan Medicaid	$5.99
Rate for Payer: Ohana Health Plan Medicare	$1.08
Rate for Payer: Ohana Health Plan Medicare	$5.99
Rate for Payer: UnitedHealthcare Medicare	$1.08
Rate for Payer: UnitedHealthcare Medicare	$5.99
Rate for Payer: University Health Alliance Commercial	$4.85
Rate for Payer: University Health Alliance Commercial	$0.87

METFORMIN 850 MG PO TABLET

Facility

$6.65

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$6.45
Rate for Payer: Cash Price	$4.32
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$5.65
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$5.99
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$6.45

METHADONE 10 MG PO TABLET

Facility

$3.74

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$3.63
Rate for Payer: Cash Price	$2.43
Rate for Payer: Health Management Network Commercial	$3.18
Rate for Payer: Kaiser Permanente Commercial	$3.37
Rate for Payer: MDX Hawaii PPO	$3.63

METHADONE 10 MG PO TABLET

Facility

$3.74

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$3.70
Rate for Payer: AlohaCare Medicaid	$1.87
Rate for Payer: AlohaCare Medicare	$3.37
Rate for Payer: Cash Price	$2.43
Rate for Payer: Devoted Health Medicare	$3.70
Rate for Payer: Hawaii Medical Service Association Medicare	$3.37
Rate for Payer: Hawaii Western Management Group Commercial	$3.55
Rate for Payer: Health Management Network Commercial	$3.18
Rate for Payer: Humana Medicare	$3.37
Rate for Payer: Kaiser Permanente Commercial	$3.37
Rate for Payer: Kaiser Permanente Medicaid	$1.91
Rate for Payer: Kaiser Permanente Medicare	$3.37
Rate for Payer: MDX Hawaii PPO	$3.63
Rate for Payer: Ohana Health Plan Medicaid	$3.37
Rate for Payer: Ohana Health Plan Medicare	$3.37
Rate for Payer: UnitedHealthcare Medicare	$3.37
Rate for Payer: University Health Alliance Commercial	$2.73

Know your out-of-pocket cost for care.

All Charges