|
NIFEDIPINE 10 MG CAPSULE [5558]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 00904722961
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
|
|
NIFEDIPINE 10 MG CAPSULE [5558]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 69315021101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
|
|
NIFEDIPINE 20 MG CAPSULE [5559]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 69315021201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.10
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
|
|
NIFEDIPINE 20 MG CAPSULE [5559]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 69315021201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: AlohaCare Medicaid |
$4.50
|
| Rate for Payer: AlohaCare Medicare |
$6.84
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Devoted Health Medicare |
$7.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.55
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Humana Medicare |
$6.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.84
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.84
|
| Rate for Payer: University Health Alliance Commercial |
$6.56
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE [10719]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 50742062001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
|
|
NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE [10719]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 50742062001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: AlohaCare Medicaid |
$2.50
|
| Rate for Payer: AlohaCare Medicare |
$3.80
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Devoted Health Medicare |
$4.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Humana Medicare |
$3.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.80
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.80
|
| Rate for Payer: University Health Alliance Commercial |
$3.64
|
|
|
NIM EMG CONTACT TUBE 7.0MM
|
Facility
|
IP
|
$1,481.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,258.85 |
| Max. Negotiated Rate |
$1,436.57 |
| Rate for Payer: Cash Price |
$888.60
|
| Rate for Payer: Health Management Network Commercial |
$1,258.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,332.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,436.57
|
|
|
NIM EMG CONTACT TUBE 7.0MM
|
Facility
|
OP
|
$1,481.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$740.50 |
| Max. Negotiated Rate |
$1,436.57 |
| Rate for Payer: AlohaCare Medicaid |
$740.50
|
| Rate for Payer: AlohaCare Medicare |
$1,125.56
|
| Rate for Payer: Cash Price |
$888.60
|
| Rate for Payer: Devoted Health Medicare |
$1,244.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,125.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,406.95
|
| Rate for Payer: Health Management Network Commercial |
$1,258.85
|
| Rate for Payer: Humana Medicare |
$1,125.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,332.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$755.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,125.56
|
| Rate for Payer: MDX Hawaii PPO |
$1,436.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,125.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,125.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,125.56
|
| Rate for Payer: University Health Alliance Commercial |
$1,079.50
|
|
|
NIM ENDO-TRACH TUBE 6.0MM X 9.
|
Facility
|
IP
|
$1,548.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,315.80 |
| Max. Negotiated Rate |
$1,501.56 |
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Health Management Network Commercial |
$1,315.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,393.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,501.56
|
|
|
NIM ENDO-TRACH TUBE 6.0MM X 9.
|
Facility
|
OP
|
$1,548.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$774.00 |
| Max. Negotiated Rate |
$1,501.56 |
| Rate for Payer: AlohaCare Medicaid |
$774.00
|
| Rate for Payer: AlohaCare Medicare |
$1,176.48
|
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Devoted Health Medicare |
$1,300.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,176.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,470.60
|
| Rate for Payer: Health Management Network Commercial |
$1,315.80
|
| Rate for Payer: Humana Medicare |
$1,176.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,393.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$789.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,176.48
|
| Rate for Payer: MDX Hawaii PPO |
$1,501.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,176.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,176.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,176.48
|
| Rate for Payer: University Health Alliance Commercial |
$1,128.34
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
NDC 69452020907
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
NDC 69452020913
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: AlohaCare Medicare |
$37.24
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Devoted Health Medicare |
$41.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.55
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Humana Medicare |
$37.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.24
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.24
|
| Rate for Payer: University Health Alliance Commercial |
$35.72
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
NDC 69452020913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
NDC 69452020907
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: AlohaCare Medicare |
$37.24
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Devoted Health Medicare |
$41.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.55
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Humana Medicare |
$37.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.24
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.24
|
| Rate for Payer: University Health Alliance Commercial |
$35.72
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
NDC 69452020920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.95 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
NDC 69452020920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: AlohaCare Medicaid |
$23.50
|
| Rate for Payer: AlohaCare Medicare |
$35.72
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Devoted Health Medicare |
$39.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.65
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Humana Medicare |
$35.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.72
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.72
|
| Rate for Payer: University Health Alliance Commercial |
$34.26
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [193835]
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
NDC 49281057488
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$851.70 |
| Max. Negotiated Rate |
$971.94 |
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Health Management Network Commercial |
$851.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$901.80
|
| Rate for Payer: MDX Hawaii PPO |
$971.94
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE [193835]
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
NDC 49281057415
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$851.70 |
| Max. Negotiated Rate |
$971.94 |
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Health Management Network Commercial |
$851.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$901.80
|
| Rate for Payer: MDX Hawaii PPO |
$971.94
|
|
|
NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [193834]
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
NDC 49281057500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$851.70 |
| Max. Negotiated Rate |
$971.94 |
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Health Management Network Commercial |
$851.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$901.80
|
| Rate for Payer: MDX Hawaii PPO |
$971.94
|
|
|
NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE [193834]
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
NDC 49281057515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$851.70 |
| Max. Negotiated Rate |
$971.94 |
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Health Management Network Commercial |
$851.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$901.80
|
| Rate for Payer: MDX Hawaii PPO |
$971.94
|
|
|
NITINOL STONE EXTRACTOR G36251
|
Facility
|
OP
|
$1,264.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$632.00 |
| Max. Negotiated Rate |
$1,226.08 |
| Rate for Payer: AlohaCare Medicaid |
$632.00
|
| Rate for Payer: AlohaCare Medicare |
$960.64
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Devoted Health Medicare |
$1,061.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$960.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,200.80
|
| Rate for Payer: Health Management Network Commercial |
$1,074.40
|
| Rate for Payer: Humana Medicare |
$960.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,137.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$644.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$960.64
|
| Rate for Payer: MDX Hawaii PPO |
$1,226.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$960.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$960.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$960.64
|
| Rate for Payer: University Health Alliance Commercial |
$921.33
|
|
|
NITINOL STONE EXTRACTOR G36251
|
Facility
|
IP
|
$1,264.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,074.40 |
| Max. Negotiated Rate |
$1,226.08 |
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Health Management Network Commercial |
$1,074.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,137.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,226.08
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 68001038500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$6.08
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Devoted Health Medicare |
$6.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.60
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Humana Medicare |
$6.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.08
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.08
|
| Rate for Payer: University Health Alliance Commercial |
$5.83
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
NDC 60687047201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: AlohaCare Medicaid |
$8.00
|
| Rate for Payer: AlohaCare Medicare |
$12.16
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Devoted Health Medicare |
$13.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Humana Medicare |
$12.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.16
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.16
|
| Rate for Payer: University Health Alliance Commercial |
$11.66
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 68001060400
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$6.08
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Devoted Health Medicare |
$6.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.60
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Humana Medicare |
$6.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.08
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.08
|
| Rate for Payer: University Health Alliance Commercial |
$5.83
|
|
