Kona Community Hospital

All Charges

Charge

Type

Setting

Price

METHYL SALICYLATE-MENTHOL 30-10 % TOP CR

Facility

$25.60

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$21.76
Max. Negotiated Rate	$24.83
Rate for Payer: Cash Price	$16.64
Rate for Payer: Health Management Network Commercial	$21.76
Rate for Payer: MDX Hawaii PPO	$24.83

METHYL SALICYLATE-MENTHOL 30-10 % TOP CR

Facility

$25.60

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$13.06
Max. Negotiated Rate	$24.83
Rate for Payer: Cash Price	$16.64
Rate for Payer: Hawaii Western Management Group Commercial	$24.32
Rate for Payer: Health Management Network Commercial	$21.76
Rate for Payer: Kaiser Permanente Commercial	$16.13
Rate for Payer: Kaiser Permanente Medicaid	$13.06
Rate for Payer: MDX Hawaii PPO	$24.83
Rate for Payer: UnitedHealthcare Medicaid	$15.36
Rate for Payer: University Health Alliance Commercial	$18.66

METOCLOPRAMIDE HCL 10 MG PO TABLET

Facility

$1.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.49
Rate for Payer: Cash Price	$1.00
Rate for Payer: Cash Price	$2.59
Rate for Payer: Health Management Network Commercial	$3.38
Rate for Payer: Health Management Network Commercial	$1.31
Rate for Payer: MDX Hawaii PPO	$1.49
Rate for Payer: MDX Hawaii PPO	$3.86

METOCLOPRAMIDE HCL 10 MG PO TABLET

Facility

$3.98

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$3.86
Rate for Payer: Cash Price	$2.59
Rate for Payer: Cash Price	$1.00
Rate for Payer: Hawaii Western Management Group Commercial	$1.46
Rate for Payer: Hawaii Western Management Group Commercial	$3.78
Rate for Payer: Health Management Network Commercial	$1.31
Rate for Payer: Health Management Network Commercial	$3.38
Rate for Payer: Kaiser Permanente Commercial	$0.97
Rate for Payer: Kaiser Permanente Commercial	$2.51
Rate for Payer: Kaiser Permanente Medicaid	$0.79
Rate for Payer: Kaiser Permanente Medicaid	$2.03
Rate for Payer: MDX Hawaii PPO	$1.49
Rate for Payer: MDX Hawaii PPO	$3.86
Rate for Payer: UnitedHealthcare Medicaid	$0.92
Rate for Payer: UnitedHealthcare Medicaid	$2.39
Rate for Payer: University Health Alliance Commercial	$2.90
Rate for Payer: University Health Alliance Commercial	$1.12

METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN

Facility

$22.21

Service Code	HCPCS J2765
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$21.54
Rate for Payer: Cash Price	$14.44
Rate for Payer: Cash Price	$14.44
Rate for Payer: Hawaii Medical Service Association ABD	$1.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.00
Rate for Payer: Hawaii Western Management Group Commercial	$21.10
Rate for Payer: Health Management Network Commercial	$18.88
Rate for Payer: Kaiser Permanente Commercial	$13.99
Rate for Payer: Kaiser Permanente Medicaid	$11.33
Rate for Payer: MDX Hawaii PPO	$21.54
Rate for Payer: UnitedHealthcare Medicaid	$13.33
Rate for Payer: University Health Alliance Commercial	$16.19

METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN

Facility

$22.21

Service Code	HCPCS J2765
Hospital Revenue Code	250
Min. Negotiated Rate	$18.88
Max. Negotiated Rate	$21.54
Rate for Payer: Cash Price	$14.44
Rate for Payer: Health Management Network Commercial	$18.88
Rate for Payer: MDX Hawaii PPO	$21.54

METOCLOPRAMIDE HCL 5 MG PO TABLET

Facility

$4.99

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$4.84
Rate for Payer: Cash Price	$3.24
Rate for Payer: Health Management Network Commercial	$4.24
Rate for Payer: MDX Hawaii PPO	$4.84

METOCLOPRAMIDE HCL 5 MG PO TABLET

Facility

$4.99

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$4.84
Rate for Payer: Cash Price	$3.24
Rate for Payer: Hawaii Western Management Group Commercial	$4.74
Rate for Payer: Health Management Network Commercial	$4.24
Rate for Payer: Kaiser Permanente Commercial	$3.14
Rate for Payer: Kaiser Permanente Medicaid	$2.54
Rate for Payer: MDX Hawaii PPO	$4.84
Rate for Payer: UnitedHealthcare Medicaid	$2.99
Rate for Payer: University Health Alliance Commercial	$3.64

METOLAZONE 2.5 MG PO TABLET

Facility

$18.22

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$17.67
Rate for Payer: Cash Price	$11.84
Rate for Payer: Cash Price	$7.44
Rate for Payer: Hawaii Western Management Group Commercial	$10.88
Rate for Payer: Hawaii Western Management Group Commercial	$17.31
Rate for Payer: Health Management Network Commercial	$9.73
Rate for Payer: Health Management Network Commercial	$15.49
Rate for Payer: Kaiser Permanente Commercial	$7.21
Rate for Payer: Kaiser Permanente Commercial	$11.48
Rate for Payer: Kaiser Permanente Medicaid	$5.84
Rate for Payer: Kaiser Permanente Medicaid	$9.29
Rate for Payer: MDX Hawaii PPO	$11.11
Rate for Payer: MDX Hawaii PPO	$17.67
Rate for Payer: UnitedHealthcare Medicaid	$6.87
Rate for Payer: UnitedHealthcare Medicaid	$10.93
Rate for Payer: University Health Alliance Commercial	$13.28
Rate for Payer: University Health Alliance Commercial	$8.35

METOLAZONE 2.5 MG PO TABLET

Facility

$11.45

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.73
Max. Negotiated Rate	$11.11
Rate for Payer: Cash Price	$7.44
Rate for Payer: Cash Price	$11.84
Rate for Payer: Health Management Network Commercial	$15.49
Rate for Payer: Health Management Network Commercial	$9.73
Rate for Payer: MDX Hawaii PPO	$11.11
Rate for Payer: MDX Hawaii PPO	$17.67

METOLAZONE 5 MG PO TABLET

Facility

$13.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.06
Max. Negotiated Rate	$12.62
Rate for Payer: Cash Price	$8.46
Rate for Payer: Cash Price	$9.42
Rate for Payer: Health Management Network Commercial	$11.06
Rate for Payer: Health Management Network Commercial	$12.32
Rate for Payer: MDX Hawaii PPO	$12.62
Rate for Payer: MDX Hawaii PPO	$14.06

METOLAZONE 5 MG PO TABLET

Facility

$14.49

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$14.06
Rate for Payer: Cash Price	$9.42
Rate for Payer: Cash Price	$8.46
Rate for Payer: Hawaii Western Management Group Commercial	$12.36
Rate for Payer: Hawaii Western Management Group Commercial	$13.77
Rate for Payer: Health Management Network Commercial	$11.06
Rate for Payer: Health Management Network Commercial	$12.32
Rate for Payer: Kaiser Permanente Commercial	$9.13
Rate for Payer: Kaiser Permanente Commercial	$8.20
Rate for Payer: Kaiser Permanente Medicaid	$7.39
Rate for Payer: Kaiser Permanente Medicaid	$6.64
Rate for Payer: MDX Hawaii PPO	$12.62
Rate for Payer: MDX Hawaii PPO	$14.06
Rate for Payer: UnitedHealthcare Medicaid	$7.81
Rate for Payer: UnitedHealthcare Medicaid	$8.69
Rate for Payer: University Health Alliance Commercial	$10.56
Rate for Payer: University Health Alliance Commercial	$9.48

METOPROLOL SUCCINATE 25 MG PO TAB SR 24H

Facility

$4.23

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$4.10
Rate for Payer: Cash Price	$2.75
Rate for Payer: Cash Price	$4.00
Rate for Payer: Health Management Network Commercial	$5.24
Rate for Payer: Health Management Network Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$4.10
Rate for Payer: MDX Hawaii PPO	$5.98

METOPROLOL SUCCINATE 25 MG PO TAB SR 24H

Facility

$4.23

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$4.10
Rate for Payer: Cash Price	$2.75
Rate for Payer: Cash Price	$4.00
Rate for Payer: Hawaii Western Management Group Commercial	$4.02
Rate for Payer: Hawaii Western Management Group Commercial	$5.85
Rate for Payer: Health Management Network Commercial	$3.60
Rate for Payer: Health Management Network Commercial	$5.24
Rate for Payer: Kaiser Permanente Commercial	$2.66
Rate for Payer: Kaiser Permanente Commercial	$3.88
Rate for Payer: Kaiser Permanente Medicaid	$2.16
Rate for Payer: Kaiser Permanente Medicaid	$3.14
Rate for Payer: MDX Hawaii PPO	$4.10
Rate for Payer: MDX Hawaii PPO	$5.98
Rate for Payer: UnitedHealthcare Medicaid	$3.70
Rate for Payer: UnitedHealthcare Medicaid	$2.54
Rate for Payer: University Health Alliance Commercial	$3.08
Rate for Payer: University Health Alliance Commercial	$4.49

METOPROLOL SUCCINATE 50 MG PO TAB SR 24H

Facility

$6.16

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$5.98
Rate for Payer: Cash Price	$4.00
Rate for Payer: Hawaii Western Management Group Commercial	$5.85
Rate for Payer: Health Management Network Commercial	$5.24
Rate for Payer: Kaiser Permanente Commercial	$3.88
Rate for Payer: Kaiser Permanente Medicaid	$3.14
Rate for Payer: MDX Hawaii PPO	$5.98
Rate for Payer: UnitedHealthcare Medicaid	$3.70
Rate for Payer: University Health Alliance Commercial	$4.49

METOPROLOL SUCCINATE 50 MG PO TAB SR 24H

Facility

$6.16

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$5.98
Rate for Payer: Cash Price	$4.00
Rate for Payer: Health Management Network Commercial	$5.24
Rate for Payer: MDX Hawaii PPO	$5.98

METOPROLOL TARTRATE 25 MG PO TABLET

Facility

$1.35

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.31
Rate for Payer: Cash Price	$0.88
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$1.15
Rate for Payer: MDX Hawaii PPO	$1.31
Rate for Payer: MDX Hawaii PPO	$1.16

METOPROLOL TARTRATE 25 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	$0.88
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Hawaii Western Management Group Commercial	$1.28
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$1.15
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.85
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicaid	$0.69
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$1.31
Rate for Payer: UnitedHealthcare Medicaid	$0.81
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87
Rate for Payer: University Health Alliance Commercial	$0.98

METOPROLOL TARTRATE 50 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: MDX Hawaii PPO	$1.16

METOPROLOL TARTRATE 50 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: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87

METOPROLOL TARTRATE 5 MG/5 ML IV SOLN

Facility

$7.15

Service Code	HCPCS J0616
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$6.94
Rate for Payer: Cash Price	$4.65
Rate for Payer: Cash Price	$3.59
Rate for Payer: Cash Price	$3.59
Rate for Payer: Cash Price	$4.65
Rate for Payer: Hawaii Medical Service Association ABD	$0.13
Rate for Payer: Hawaii Medical Service Association ABD	$0.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.13
Rate for Payer: Hawaii Western Management Group Commercial	$5.24
Rate for Payer: Hawaii Western Management Group Commercial	$6.79
Rate for Payer: Health Management Network Commercial	$6.08
Rate for Payer: Health Management Network Commercial	$4.69
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Commercial	$3.48
Rate for Payer: Kaiser Permanente Medicaid	$2.82
Rate for Payer: Kaiser Permanente Medicaid	$3.65
Rate for Payer: MDX Hawaii PPO	$5.35
Rate for Payer: MDX Hawaii PPO	$6.94
Rate for Payer: UnitedHealthcare Medicaid	$3.31
Rate for Payer: UnitedHealthcare Medicaid	$4.29
Rate for Payer: University Health Alliance Commercial	$4.02
Rate for Payer: University Health Alliance Commercial	$5.21

METOPROLOL TARTRATE 5 MG/5 ML IV SOLN

Facility

$5.52

Service Code	HCPCS J0616
Hospital Revenue Code	250
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$5.35
Rate for Payer: Cash Price	$3.59
Rate for Payer: Cash Price	$4.65
Rate for Payer: Health Management Network Commercial	$6.08
Rate for Payer: Health Management Network Commercial	$4.69
Rate for Payer: MDX Hawaii PPO	$6.94
Rate for Payer: MDX Hawaii PPO	$5.35

METRONIDAZOLE 0.75 % VAG GEL

Facility

$557.24

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$284.19
Max. Negotiated Rate	$540.52
Rate for Payer: Cash Price	$362.21
Rate for Payer: Hawaii Western Management Group Commercial	$529.38
Rate for Payer: Health Management Network Commercial	$473.65
Rate for Payer: Kaiser Permanente Commercial	$351.06
Rate for Payer: Kaiser Permanente Medicaid	$284.19
Rate for Payer: MDX Hawaii PPO	$540.52
Rate for Payer: UnitedHealthcare Medicaid	$334.34
Rate for Payer: University Health Alliance Commercial	$406.17

METRONIDAZOLE 0.75 % VAG GEL

Facility

$557.24

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$473.65
Max. Negotiated Rate	$540.52
Rate for Payer: Cash Price	$362.21
Rate for Payer: Health Management Network Commercial	$473.65
Rate for Payer: MDX Hawaii PPO	$540.52

METRONIDAZOLE 250 MG PO TABLET

Facility

$2.40

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$2.33
Rate for Payer: Cash Price	$1.56
Rate for Payer: Health Management Network Commercial	$2.04
Rate for Payer: MDX Hawaii PPO	$2.33

Know your out-of-pocket cost for care.

All Charges