Kona Community Hospital

All Charges

Charge

Type

Setting

Price

METHOTREXATE SODIUM 5 MG

Professional

Both

$1.00

Service Code	HCPCS J9250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$0.85
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cash Price	$0.65
Rate for Payer: Hawaii Western Management Group Commercial	$0.74
Rate for Payer: Health Management Network Commercial	$0.85

METHOTREXATE SODIUM (PF) 25 MG/ML INJ SOLN

Facility

$18.55

Service Code	HCPCS J9260
Hospital Revenue Code	636
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$17.99
Rate for Payer: Cash Price	$12.06
Rate for Payer: Cash Price	$12.06
Rate for Payer: Hawaii Medical Service Association ABD	$2.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.26
Rate for Payer: Hawaii Western Management Group Commercial	$17.62
Rate for Payer: Health Management Network Commercial	$15.77
Rate for Payer: Kaiser Permanente Commercial	$11.69
Rate for Payer: Kaiser Permanente Medicaid	$9.46
Rate for Payer: MDX Hawaii PPO	$17.99
Rate for Payer: UnitedHealthcare Medicaid	$11.13
Rate for Payer: University Health Alliance Commercial	$13.52

METHOTREXATE SODIUM (PF) 25 MG/ML INJ SOLN

Facility

$18.55

Service Code	HCPCS J9260
Hospital Revenue Code	250
Min. Negotiated Rate	$15.77
Max. Negotiated Rate	$17.99
Rate for Payer: Cash Price	$12.06
Rate for Payer: Health Management Network Commercial	$15.77
Rate for Payer: MDX Hawaii PPO	$17.99

METHYLENE BLUE (ANTIDOTE) 0.5 % IV SOLN

Facility

$726.60

Service Code	HCPCS Q9968
Hospital Revenue Code	250
Min. Negotiated Rate	$617.61
Max. Negotiated Rate	$704.80
Rate for Payer: Cash Price	$472.29
Rate for Payer: Health Management Network Commercial	$617.61
Rate for Payer: MDX Hawaii PPO	$704.80

METHYLENE BLUE (ANTIDOTE) 0.5 % IV SOLN

Facility

$726.60

Service Code	HCPCS Q9968
Hospital Revenue Code	250
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$704.80
Rate for Payer: AlohaCare Medicaid	$10.29
Rate for Payer: AlohaCare Medicare	$10.29
Rate for Payer: Cash Price	$472.29
Rate for Payer: Cash Price	$472.29
Rate for Payer: Devoted Health Medicare	$11.32
Rate for Payer: Hawaii Medical Service Association Commercial	$12.86
Rate for Payer: Hawaii Medical Service Association Medicare	$10.29
Rate for Payer: Hawaii Western Management Group Commercial	$690.27
Rate for Payer: Health Management Network Commercial	$617.61
Rate for Payer: Humana Medicare	$10.29
Rate for Payer: Kaiser Permanente Commercial	$457.76
Rate for Payer: Kaiser Permanente Medicaid	$370.57
Rate for Payer: Kaiser Permanente Medicare	$10.29
Rate for Payer: MDX Hawaii PPO	$704.80
Rate for Payer: Ohana Health Plan Medicaid	$11.32
Rate for Payer: Ohana Health Plan Medicare	$10.29
Rate for Payer: UnitedHealthcare Medicaid	$435.96
Rate for Payer: UnitedHealthcare Medicare	$10.29
Rate for Payer: University Health Alliance Commercial	$529.62

METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN

Facility

$147.50

Service Code	HCPCS J2210
Hospital Revenue Code	636
Min. Negotiated Rate	$22.06
Max. Negotiated Rate	$143.07
Rate for Payer: Cash Price	$95.88
Rate for Payer: Cash Price	$95.88
Rate for Payer: Hawaii Medical Service Association ABD	$22.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.06
Rate for Payer: Hawaii Western Management Group Commercial	$140.12
Rate for Payer: Health Management Network Commercial	$125.38
Rate for Payer: Kaiser Permanente Commercial	$92.92
Rate for Payer: Kaiser Permanente Medicaid	$75.22
Rate for Payer: MDX Hawaii PPO	$143.07
Rate for Payer: UnitedHealthcare Medicaid	$88.50
Rate for Payer: University Health Alliance Commercial	$107.51

METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN

Facility

$147.50

Service Code	HCPCS J2210
Hospital Revenue Code	250
Min. Negotiated Rate	$125.38
Max. Negotiated Rate	$143.07
Rate for Payer: Cash Price	$95.88
Rate for Payer: Health Management Network Commercial	$125.38
Rate for Payer: MDX Hawaii PPO	$143.07

METHYLERGONOVINE 0.2 MG PO TABLET

Facility

$331.95

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$282.16
Max. Negotiated Rate	$321.99
Rate for Payer: Cash Price	$215.77
Rate for Payer: Health Management Network Commercial	$282.16
Rate for Payer: MDX Hawaii PPO	$321.99

METHYLERGONOVINE 0.2 MG PO TABLET

Facility

$331.95

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$169.29
Max. Negotiated Rate	$321.99
Rate for Payer: Cash Price	$215.77
Rate for Payer: Hawaii Western Management Group Commercial	$315.35
Rate for Payer: Health Management Network Commercial	$282.16
Rate for Payer: Kaiser Permanente Commercial	$209.13
Rate for Payer: Kaiser Permanente Medicaid	$169.29
Rate for Payer: MDX Hawaii PPO	$321.99
Rate for Payer: UnitedHealthcare Medicaid	$199.17
Rate for Payer: University Health Alliance Commercial	$241.96

METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLN

Facility

$592.78

Service Code	HCPCS J2212
Hospital Revenue Code	637
Min. Negotiated Rate	$302.32
Max. Negotiated Rate	$575.00
Rate for Payer: Cash Price	$385.31
Rate for Payer: Hawaii Western Management Group Commercial	$563.14
Rate for Payer: Health Management Network Commercial	$503.86
Rate for Payer: Kaiser Permanente Commercial	$373.45
Rate for Payer: Kaiser Permanente Medicaid	$302.32
Rate for Payer: MDX Hawaii PPO	$575.00
Rate for Payer: University Health Alliance Commercial	$432.08

METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SOLN

Facility

$592.78

Service Code	HCPCS J2212
Hospital Revenue Code	250
Min. Negotiated Rate	$503.86
Max. Negotiated Rate	$575.00
Rate for Payer: Cash Price	$385.31
Rate for Payer: Health Management Network Commercial	$503.86
Rate for Payer: MDX Hawaii PPO	$575.00

METHYLPHENIDATE HCL 5 MG PO TABLET

Facility

$4.04

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$3.92
Rate for Payer: Cash Price	$2.63
Rate for Payer: Cash Price	$2.65
Rate for Payer: Health Management Network Commercial	$3.46
Rate for Payer: Health Management Network Commercial	$3.43
Rate for Payer: MDX Hawaii PPO	$3.92
Rate for Payer: MDX Hawaii PPO	$3.95

METHYLPHENIDATE HCL 5 MG PO TABLET

Facility

$4.04

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$3.92
Rate for Payer: Cash Price	$2.63
Rate for Payer: Cash Price	$2.65
Rate for Payer: Hawaii Western Management Group Commercial	$3.84
Rate for Payer: Hawaii Western Management Group Commercial	$3.87
Rate for Payer: Health Management Network Commercial	$3.43
Rate for Payer: Health Management Network Commercial	$3.46
Rate for Payer: Kaiser Permanente Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.56
Rate for Payer: Kaiser Permanente Medicaid	$2.08
Rate for Payer: Kaiser Permanente Medicaid	$2.06
Rate for Payer: MDX Hawaii PPO	$3.92
Rate for Payer: MDX Hawaii PPO	$3.95
Rate for Payer: UnitedHealthcare Medicaid	$2.44
Rate for Payer: UnitedHealthcare Medicaid	$2.42
Rate for Payer: University Health Alliance Commercial	$2.94
Rate for Payer: University Health Alliance Commercial	$2.97

METHYLPREDNISOLONE 4 MG PO TABLET

Facility

$9.11

Service Code	HCPCS J7509
Hospital Revenue Code	636
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$8.84
Rate for Payer: Cash Price	$5.92
Rate for Payer: Cash Price	$5.92
Rate for Payer: Hawaii Medical Service Association ABD	$0.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.23
Rate for Payer: Hawaii Western Management Group Commercial	$8.65
Rate for Payer: Health Management Network Commercial	$7.74
Rate for Payer: Kaiser Permanente Commercial	$5.74
Rate for Payer: Kaiser Permanente Medicaid	$4.65
Rate for Payer: MDX Hawaii PPO	$8.84
Rate for Payer: UnitedHealthcare Medicaid	$5.47
Rate for Payer: University Health Alliance Commercial	$6.64

METHYLPREDNISOLONE 4 MG PO TABLET

Facility

$9.11

Service Code	HCPCS J7509
Hospital Revenue Code	250
Min. Negotiated Rate	$7.74
Max. Negotiated Rate	$8.84
Rate for Payer: Cash Price	$5.92
Rate for Payer: Health Management Network Commercial	$7.74
Rate for Payer: MDX Hawaii PPO	$8.84

METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP

Facility

$65.87

Service Code	HCPCS J1010
Hospital Revenue Code	250
Min. Negotiated Rate	$55.99
Max. Negotiated Rate	$63.89
Rate for Payer: Cash Price	$42.82
Rate for Payer: Health Management Network Commercial	$55.99
Rate for Payer: MDX Hawaii PPO	$63.89

METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP

Facility

$65.87

Service Code	HCPCS J1010
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$63.89
Rate for Payer: Cash Price	$42.82
Rate for Payer: Cash Price	$42.82
Rate for Payer: Hawaii Medical Service Association ABD	$0.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.12
Rate for Payer: Hawaii Western Management Group Commercial	$62.58
Rate for Payer: Health Management Network Commercial	$55.99
Rate for Payer: Kaiser Permanente Commercial	$41.50
Rate for Payer: Kaiser Permanente Medicaid	$33.59
Rate for Payer: MDX Hawaii PPO	$63.89
Rate for Payer: UnitedHealthcare Medicaid	$39.52
Rate for Payer: University Health Alliance Commercial	$48.01

METHYLPREDNISOLONE SODIUM SUCC 1000 MG IV RECON.SOLN.

Facility

$200.08

Service Code	HCPCS J2919
Hospital Revenue Code	250
Min. Negotiated Rate	$170.07
Max. Negotiated Rate	$194.08
Rate for Payer: Cash Price	$130.05
Rate for Payer: Cash Price	$124.43
Rate for Payer: Health Management Network Commercial	$162.72
Rate for Payer: Health Management Network Commercial	$170.07
Rate for Payer: MDX Hawaii PPO	$194.08
Rate for Payer: MDX Hawaii PPO	$185.69

METHYLPREDNISOLONE SODIUM SUCC 1000 MG IV RECON.SOLN.

Facility

$191.43

Service Code	HCPCS J2919
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$185.69
Rate for Payer: Cash Price	$124.43
Rate for Payer: Cash Price	$124.43
Rate for Payer: Cash Price	$130.05
Rate for Payer: Cash Price	$130.05
Rate for Payer: Hawaii Medical Service Association ABD	$0.26
Rate for Payer: Hawaii Medical Service Association ABD	$0.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.26
Rate for Payer: Hawaii Western Management Group Commercial	$181.86
Rate for Payer: Hawaii Western Management Group Commercial	$190.08
Rate for Payer: Health Management Network Commercial	$162.72
Rate for Payer: Health Management Network Commercial	$170.07
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: Kaiser Permanente Commercial	$126.05
Rate for Payer: Kaiser Permanente Medicaid	$102.04
Rate for Payer: Kaiser Permanente Medicaid	$97.63
Rate for Payer: MDX Hawaii PPO	$194.08
Rate for Payer: MDX Hawaii PPO	$185.69
Rate for Payer: UnitedHealthcare Medicaid	$114.86
Rate for Payer: UnitedHealthcare Medicaid	$120.05
Rate for Payer: University Health Alliance Commercial	$139.53
Rate for Payer: University Health Alliance Commercial	$145.84

METHYLPREDNISOLONE SODIUM SUCC 500 MG IV RECON.SOLN.

Facility

$109.08

Service Code	HCPCS J2919
Hospital Revenue Code	250
Min. Negotiated Rate	$92.72
Max. Negotiated Rate	$105.81
Rate for Payer: Cash Price	$70.90
Rate for Payer: Cash Price	$77.04
Rate for Payer: Health Management Network Commercial	$92.72
Rate for Payer: Health Management Network Commercial	$100.74
Rate for Payer: MDX Hawaii PPO	$105.81
Rate for Payer: MDX Hawaii PPO	$114.96

METHYLPREDNISOLONE SODIUM SUCC 500 MG IV RECON.SOLN.

Facility

$118.52

Service Code	HCPCS J2919
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$114.96
Rate for Payer: Cash Price	$77.04
Rate for Payer: Cash Price	$70.90
Rate for Payer: Cash Price	$70.90
Rate for Payer: Cash Price	$77.04
Rate for Payer: Hawaii Medical Service Association ABD	$0.26
Rate for Payer: Hawaii Medical Service Association ABD	$0.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.26
Rate for Payer: Hawaii Western Management Group Commercial	$103.63
Rate for Payer: Hawaii Western Management Group Commercial	$112.59
Rate for Payer: Health Management Network Commercial	$100.74
Rate for Payer: Health Management Network Commercial	$92.72
Rate for Payer: Kaiser Permanente Commercial	$74.67
Rate for Payer: Kaiser Permanente Commercial	$68.72
Rate for Payer: Kaiser Permanente Medicaid	$55.63
Rate for Payer: Kaiser Permanente Medicaid	$60.45
Rate for Payer: MDX Hawaii PPO	$105.81
Rate for Payer: MDX Hawaii PPO	$114.96
Rate for Payer: UnitedHealthcare Medicaid	$71.11
Rate for Payer: UnitedHealthcare Medicaid	$65.45
Rate for Payer: University Health Alliance Commercial	$86.39
Rate for Payer: University Health Alliance Commercial	$79.51

METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ RECON.SOLN.

Facility

$40.89

Service Code	HCPCS J2919
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$39.66
Rate for Payer: Cash Price	$26.58
Rate for Payer: Cash Price	$26.58
Rate for Payer: Hawaii Medical Service Association ABD	$0.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.26
Rate for Payer: Hawaii Western Management Group Commercial	$38.85
Rate for Payer: Health Management Network Commercial	$34.76
Rate for Payer: Kaiser Permanente Commercial	$25.76
Rate for Payer: Kaiser Permanente Medicaid	$20.85
Rate for Payer: MDX Hawaii PPO	$39.66
Rate for Payer: UnitedHealthcare Medicaid	$24.53
Rate for Payer: University Health Alliance Commercial	$29.80

METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ RECON.SOLN.

Facility

$40.89

Service Code	HCPCS J2919
Hospital Revenue Code	250
Min. Negotiated Rate	$34.76
Max. Negotiated Rate	$39.66
Rate for Payer: Cash Price	$26.58
Rate for Payer: Health Management Network Commercial	$34.76
Rate for Payer: MDX Hawaii PPO	$39.66

METHYLPREDNISOLONE SOD SUC(PF) 62.5 MG/ML INJ RECON.SOLN.

Facility

$59.99

Service Code	HCPCS J2919
Hospital Revenue Code	250
Min. Negotiated Rate	$50.99
Max. Negotiated Rate	$58.19
Rate for Payer: Cash Price	$38.99
Rate for Payer: Health Management Network Commercial	$50.99
Rate for Payer: MDX Hawaii PPO	$58.19

METHYLPREDNISOLONE SOD SUC(PF) 62.5 MG/ML INJ RECON.SOLN.

Facility

$59.99

Service Code	HCPCS J2919
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$58.19
Rate for Payer: Cash Price	$38.99
Rate for Payer: Cash Price	$38.99
Rate for Payer: Hawaii Medical Service Association ABD	$0.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.26
Rate for Payer: Hawaii Western Management Group Commercial	$56.99
Rate for Payer: Health Management Network Commercial	$50.99
Rate for Payer: Kaiser Permanente Commercial	$37.79
Rate for Payer: Kaiser Permanente Medicaid	$30.59
Rate for Payer: MDX Hawaii PPO	$58.19
Rate for Payer: UnitedHealthcare Medicaid	$35.99
Rate for Payer: University Health Alliance Commercial	$43.73

Know your out-of-pocket cost for care.

All Charges