Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Mesh Ventralight ST 6" Circle 5954600 [3642799]

Facility

$5,418.80

Service Code	HCPCS C1781
Hospital Charge Code	3642799
Hospital Revenue Code	278
Min. Negotiated Rate	$3,034.53
Max. Negotiated Rate	$5,256.24
Rate for Payer: Cash Price	$3,522.22
Rate for Payer: Hawaii Western Management Group Commercial	$3,793.16
Rate for Payer: Health Management Network Commercial	$4,605.98
Rate for Payer: MDX Hawaii PPO	$5,256.24
Rate for Payer: University Health Alliance Commercial	$3,034.53

Mesh Ventralight ST 6" Circle 5954600 [3642799]

Facility

$5,418.80

Service Code	HCPCS C1781
Hospital Charge Code	3642799
Hospital Revenue Code	278
Min. Negotiated Rate	$2,763.59
Max. Negotiated Rate	$5,256.24
Rate for Payer: Cash Price	$3,522.22
Rate for Payer: Hawaii Western Management Group Commercial	$3,793.16
Rate for Payer: Health Management Network Commercial	$4,605.98
Rate for Payer: Kaiser Permanente Commercial	$3,413.84
Rate for Payer: Kaiser Permanente Medicaid	$2,763.59
Rate for Payer: MDX Hawaii PPO	$5,256.24
Rate for Payer: University Health Alliance Commercial	$3,034.53

Mesh Ventralight ST 8X10IN 5954810 [3603346]

Facility

$9,274.40

Service Code	HCPCS C1781
Hospital Charge Code	3603346
Hospital Revenue Code	278
Min. Negotiated Rate	$4,729.94
Max. Negotiated Rate	$8,996.17
Rate for Payer: Cash Price	$6,028.36
Rate for Payer: Hawaii Western Management Group Commercial	$6,492.08
Rate for Payer: Health Management Network Commercial	$7,883.24
Rate for Payer: Kaiser Permanente Commercial	$5,842.87
Rate for Payer: Kaiser Permanente Medicaid	$4,729.94
Rate for Payer: MDX Hawaii PPO	$8,996.17
Rate for Payer: University Health Alliance Commercial	$5,193.66

Mesh Ventralight ST 8X10IN 5954810 [3603346]

Facility

$9,274.40

Service Code	HCPCS C1781
Hospital Charge Code	3603346
Hospital Revenue Code	278
Min. Negotiated Rate	$5,193.66
Max. Negotiated Rate	$8,996.17
Rate for Payer: Cash Price	$6,028.36
Rate for Payer: Hawaii Western Management Group Commercial	$6,492.08
Rate for Payer: Health Management Network Commercial	$7,883.24
Rate for Payer: MDX Hawaii PPO	$8,996.17
Rate for Payer: University Health Alliance Commercial	$5,193.66

Mesh Vicryl Knitted 30cmX30cm VKML [3642995]

Facility

$8,127.24

Service Code	HCPCS C1781
Hospital Charge Code	3642995
Hospital Revenue Code	278
Min. Negotiated Rate	$4,144.89
Max. Negotiated Rate	$7,883.42
Rate for Payer: Cash Price	$5,282.71
Rate for Payer: Hawaii Western Management Group Commercial	$5,689.07
Rate for Payer: Health Management Network Commercial	$6,908.15
Rate for Payer: Kaiser Permanente Commercial	$5,120.16
Rate for Payer: Kaiser Permanente Medicaid	$4,144.89
Rate for Payer: MDX Hawaii PPO	$7,883.42
Rate for Payer: University Health Alliance Commercial	$4,551.25

Mesh Vicryl Knitted 30cmX30cm VKML [3642995]

Facility

$8,127.24

Service Code	HCPCS C1781
Hospital Charge Code	3642995
Hospital Revenue Code	278
Min. Negotiated Rate	$4,551.25
Max. Negotiated Rate	$7,883.42
Rate for Payer: Cash Price	$5,282.71
Rate for Payer: Hawaii Western Management Group Commercial	$5,689.07
Rate for Payer: Health Management Network Commercial	$6,908.15
Rate for Payer: MDX Hawaii PPO	$7,883.42
Rate for Payer: University Health Alliance Commercial	$4,551.25

METFORMIN 500 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: Cash Price	$2.52
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$3.29
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$3.75

METFORMIN 500 MG PO TABLET

Facility

$3.87

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$3.75
Rate for Payer: Cash Price	$2.52
Rate for Payer: Cash Price	$0.78
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Hawaii Western Management Group Commercial	$3.68
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$3.29
Rate for Payer: Kaiser Permanente Commercial	$2.44
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$1.97
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$3.75
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: UnitedHealthcare Medicaid	$2.32
Rate for Payer: University Health Alliance Commercial	$2.82
Rate for Payer: University Health Alliance Commercial	$0.87

METFORMIN 850 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Cash Price	$4.32
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Hawaii Western Management Group Commercial	$6.32
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$5.65
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Commercial	$4.19
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicaid	$3.39
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$6.45
Rate for Payer: UnitedHealthcare Medicaid	$3.99
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87
Rate for Payer: University Health Alliance Commercial	$4.85

METFORMIN 850 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: Cash Price	$4.32
Rate for Payer: Health Management Network Commercial	$5.65
Rate for Payer: Health Management Network Commercial	$1.02
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: MDX Hawaii PPO	$3.63

METHADONE 10 MG PO TABLET

Facility

$3.74

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$3.63
Rate for Payer: Cash Price	$2.43
Rate for Payer: Hawaii Western Management Group Commercial	$3.55
Rate for Payer: Health Management Network Commercial	$3.18
Rate for Payer: Kaiser Permanente Commercial	$2.36
Rate for Payer: Kaiser Permanente Medicaid	$1.91
Rate for Payer: MDX Hawaii PPO	$3.63
Rate for Payer: UnitedHealthcare Medicaid	$2.24
Rate for Payer: University Health Alliance Commercial	$2.73

METHADONE 5 MG PO TABLET

Facility

$2.13

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$2.07
Rate for Payer: Cash Price	$1.38
Rate for Payer: Hawaii Western Management Group Commercial	$2.02
Rate for Payer: Health Management Network Commercial	$1.81
Rate for Payer: Kaiser Permanente Commercial	$1.34
Rate for Payer: Kaiser Permanente Medicaid	$1.09
Rate for Payer: MDX Hawaii PPO	$2.07
Rate for Payer: UnitedHealthcare Medicaid	$1.28
Rate for Payer: University Health Alliance Commercial	$1.55

METHADONE 5 MG PO TABLET

Facility

$2.13

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$2.07
Rate for Payer: Cash Price	$1.38
Rate for Payer: Health Management Network Commercial	$1.81
Rate for Payer: MDX Hawaii PPO	$2.07

METHENAMINE HIPPURATE 1 GRAM PO TABLET

Facility

$11.55

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.82
Max. Negotiated Rate	$11.20
Rate for Payer: Cash Price	$7.51
Rate for Payer: Cash Price	$6.26
Rate for Payer: Health Management Network Commercial	$8.19
Rate for Payer: Health Management Network Commercial	$9.82
Rate for Payer: MDX Hawaii PPO	$11.20
Rate for Payer: MDX Hawaii PPO	$9.34

METHENAMINE HIPPURATE 1 GRAM PO TABLET

Facility

$11.55

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$11.20
Rate for Payer: Cash Price	$7.51
Rate for Payer: Cash Price	$6.26
Rate for Payer: Hawaii Western Management Group Commercial	$10.97
Rate for Payer: Hawaii Western Management Group Commercial	$9.15
Rate for Payer: Health Management Network Commercial	$9.82
Rate for Payer: Health Management Network Commercial	$8.19
Rate for Payer: Kaiser Permanente Commercial	$7.28
Rate for Payer: Kaiser Permanente Commercial	$6.07
Rate for Payer: Kaiser Permanente Medicaid	$5.89
Rate for Payer: Kaiser Permanente Medicaid	$4.91
Rate for Payer: MDX Hawaii PPO	$11.20
Rate for Payer: MDX Hawaii PPO	$9.34
Rate for Payer: UnitedHealthcare Medicaid	$5.78
Rate for Payer: UnitedHealthcare Medicaid	$6.93
Rate for Payer: University Health Alliance Commercial	$8.42
Rate for Payer: University Health Alliance Commercial	$7.02

METHIMAZOLE 5 MG PO TABLET

Facility

$3.96

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$3.84
Rate for Payer: Cash Price	$2.57
Rate for Payer: Hawaii Western Management Group Commercial	$3.76
Rate for Payer: Health Management Network Commercial	$3.37
Rate for Payer: Kaiser Permanente Commercial	$2.49
Rate for Payer: Kaiser Permanente Medicaid	$2.02
Rate for Payer: MDX Hawaii PPO	$3.84
Rate for Payer: UnitedHealthcare Medicaid	$2.38
Rate for Payer: University Health Alliance Commercial	$2.89

METHIMAZOLE 5 MG PO TABLET

Facility

$3.96

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.84
Rate for Payer: Cash Price	$2.57
Rate for Payer: Health Management Network Commercial	$3.37
Rate for Payer: MDX Hawaii PPO	$3.84

METHOCARBAMOL 500 MG PO TABLET

Facility

$1.99

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.93
Rate for Payer: Cash Price	$1.29
Rate for Payer: Cash Price	$1.08
Rate for Payer: Health Management Network Commercial	$1.41
Rate for Payer: Health Management Network Commercial	$1.69
Rate for Payer: MDX Hawaii PPO	$1.93
Rate for Payer: MDX Hawaii PPO	$1.61

METHOCARBAMOL 500 MG PO TABLET

Facility

$1.66

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.61
Rate for Payer: Cash Price	$1.08
Rate for Payer: Cash Price	$1.29
Rate for Payer: Hawaii Western Management Group Commercial	$1.58
Rate for Payer: Hawaii Western Management Group Commercial	$1.89
Rate for Payer: Health Management Network Commercial	$1.41
Rate for Payer: Health Management Network Commercial	$1.69
Rate for Payer: Kaiser Permanente Commercial	$1.05
Rate for Payer: Kaiser Permanente Commercial	$1.25
Rate for Payer: Kaiser Permanente Medicaid	$0.85
Rate for Payer: Kaiser Permanente Medicaid	$1.01
Rate for Payer: MDX Hawaii PPO	$1.61
Rate for Payer: MDX Hawaii PPO	$1.93
Rate for Payer: UnitedHealthcare Medicaid	$1.19
Rate for Payer: UnitedHealthcare Medicaid	$1.00
Rate for Payer: University Health Alliance Commercial	$1.21
Rate for Payer: University Health Alliance Commercial	$1.45

METHOCARBAMOL 750 MG PO TABLET

Facility

$2.06

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$2.00
Rate for Payer: Cash Price	$1.34
Rate for Payer: Health Management Network Commercial	$1.75
Rate for Payer: MDX Hawaii PPO	$2.00

METHOCARBAMOL 750 MG PO TABLET

Facility

$2.06

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.00
Rate for Payer: Cash Price	$1.34
Rate for Payer: Hawaii Western Management Group Commercial	$1.96
Rate for Payer: Health Management Network Commercial	$1.75
Rate for Payer: Kaiser Permanente Commercial	$1.30
Rate for Payer: Kaiser Permanente Medicaid	$1.05
Rate for Payer: MDX Hawaii PPO	$2.00
Rate for Payer: UnitedHealthcare Medicaid	$1.24
Rate for Payer: University Health Alliance Commercial	$1.50

METHOTREXATE SODIUM 2.5 MG PO TABLET

Facility

$39.77

Service Code	HCPCS J8610
Hospital Revenue Code	636
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$38.58
Rate for Payer: Cash Price	$25.85
Rate for Payer: Cash Price	$25.85
Rate for Payer: Hawaii Medical Service Association ABD	$0.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.20
Rate for Payer: Hawaii Western Management Group Commercial	$37.78
Rate for Payer: Health Management Network Commercial	$33.80
Rate for Payer: Kaiser Permanente Commercial	$25.06
Rate for Payer: Kaiser Permanente Medicaid	$20.28
Rate for Payer: MDX Hawaii PPO	$38.58
Rate for Payer: UnitedHealthcare Medicaid	$23.86
Rate for Payer: University Health Alliance Commercial	$28.99

METHOTREXATE SODIUM 2.5 MG PO TABLET

Facility

$39.77

Service Code	HCPCS J8610
Hospital Revenue Code	250
Min. Negotiated Rate	$33.80
Max. Negotiated Rate	$38.58
Rate for Payer: Cash Price	$25.85
Rate for Payer: Health Management Network Commercial	$33.80
Rate for Payer: MDX Hawaii PPO	$38.58

METHOTREXATE SODIUM 50 MG

Professional

Both

$6.00

Service Code	HCPCS J9260
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$10.53
Rate for Payer: AlohaCare Medicare	$2.68
Rate for Payer: Cash Price	$3.90
Rate for Payer: Cash Price	$3.90
Rate for Payer: Devoted Health Medicare	$2.95
Rate for Payer: Hawaii Medical Service Association Medicare	$2.68
Rate for Payer: Hawaii Western Management Group Commercial	$10.53
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$3.22
Rate for Payer: Kaiser Permanente Medicaid	$3.22
Rate for Payer: Kaiser Permanente Medicare	$3.22
Rate for Payer: Ohana Health Plan Medicare	$2.68
Rate for Payer: UnitedHealthcare Medicare	$2.68

Know your out-of-pocket cost for care.

All Charges