|
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
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
NDC 69452020907
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: AlohaCare Medicare |
$15.19
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Devoted Health Medicare |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.55
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Humana Medicare |
$15.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.19
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.19
|
| 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
|
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
|
$47.00
|
|
|
Service Code
|
NDC 69452020920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: AlohaCare Medicaid |
$23.50
|
| Rate for Payer: AlohaCare Medicare |
$14.57
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Devoted Health Medicare |
$15.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.65
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Humana Medicare |
$14.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.57
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.57
|
| Rate for Payer: University Health Alliance Commercial |
$34.26
|
|
|
NIMODIPINE 30 MG CAPSULE [10722]
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
NDC 69452020913
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: AlohaCare Medicare |
$15.19
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Devoted Health Medicare |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.55
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Humana Medicare |
$15.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.19
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.19
|
| 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
|
|
|
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 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 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
|
|
|
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
|
|
|
NITINOL STONE EXTRACTOR G36251
|
Facility
|
OP
|
$1,264.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$391.84 |
| Max. Negotiated Rate |
$1,226.08 |
| Rate for Payer: AlohaCare Medicaid |
$632.00
|
| Rate for Payer: AlohaCare Medicare |
$391.84
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Devoted Health Medicare |
$429.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$391.84
|
| 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 |
$391.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,137.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$644.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$391.84
|
| Rate for Payer: MDX Hawaii PPO |
$1,226.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$391.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$391.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$391.84
|
| 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
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 68001038500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.20
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
NDC 60687047201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 68001060400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.20
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
NDC 60687047201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: AlohaCare Medicaid |
$8.00
|
| Rate for Payer: AlohaCare Medicare |
$4.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Devoted Health Medicare |
$5.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Humana Medicare |
$4.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.96
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.96
|
| 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 |
$2.48 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$2.48
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Devoted Health Medicare |
$2.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.60
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Humana Medicare |
$2.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.48
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.48
|
| Rate for Payer: University Health Alliance Commercial |
$5.83
|
|
|
NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE [5595]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 68001038500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$2.48
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Devoted Health Medicare |
$2.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.60
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Humana Medicare |
$2.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.48
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.48
|
| Rate for Payer: University Health Alliance Commercial |
$5.83
|
|
|
NITROFURANTOIN MONOHYD/M-CRYST CAPSULE (MACROBID) 100 MG (TAKE HOME) [4080380]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 00004080168
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: AlohaCare Medicaid |
$7.50
|
| Rate for Payer: AlohaCare Medicare |
$4.65
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Devoted Health Medicare |
$5.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.25
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Humana Medicare |
$4.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.65
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.65
|
| Rate for Payer: University Health Alliance Commercial |
$10.93
|
|
|
NITROFURANTOIN MONOHYD/M-CRYST CAPSULE (MACROBID) 100 MG (TAKE HOME) [4080380]
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 00004080168
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.50
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
NDC 60687063311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$12.61 |
| Rate for Payer: AlohaCare Medicaid |
$6.50
|
| Rate for Payer: AlohaCare Medicare |
$4.03
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Devoted Health Medicare |
$4.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Humana Medicare |
$4.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.03
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.03
|
| Rate for Payer: University Health Alliance Commercial |
$9.48
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
NDC 68001042300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$13.58 |
| Rate for Payer: Cash Price |
$8.40
|
| 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
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 60687063311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$12.61 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.70
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
|
|
NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE [10724]
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 70756040411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.50
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
|
