Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

nystatin 100000 units/gm powder topical [HHSC]

Facility

IP

$132.93

Service Code	NDC 42543005261
Hospital Charge Code	2500596
Hospital Revenue Code	250
Min. Negotiated Rate	$112.99
Max. Negotiated Rate	$128.94
Rate for Payer: Cash Price	$86.40
Rate for Payer: Health Management Network Commercial	$112.99
Rate for Payer: Kaiser Permanente Commercial	$119.64
Rate for Payer: MDX Hawaii PPO	$128.94

nystatin 100000 units/gm powder topical [HHSC]

Facility

IP

$174.73

Service Code	NDC 00832046515
Hospital Charge Code	2500596
Hospital Revenue Code	250
Min. Negotiated Rate	$148.52
Max. Negotiated Rate	$169.49
Rate for Payer: Cash Price	$113.57
Rate for Payer: Health Management Network Commercial	$148.52
Rate for Payer: Kaiser Permanente Commercial	$157.26
Rate for Payer: MDX Hawaii PPO	$169.49

nystatin 100000 units/gm powder topical [HHSC]

Facility

OP

$174.73

Service Code	NDC 00832046515
Hospital Charge Code	2500596
Hospital Revenue Code	250
Min. Negotiated Rate	$87.36
Max. Negotiated Rate	$169.49
Rate for Payer: AlohaCare Medicaid	$87.36
Rate for Payer: AlohaCare Medicare	$87.36
Rate for Payer: Cash Price	$113.57
Rate for Payer: Devoted Health Medicare	$96.10
Rate for Payer: Hawaii Medical Service Association Medicare	$87.36
Rate for Payer: Hawaii Western Management Group Commercial	$165.99
Rate for Payer: Health Management Network Commercial	$148.52
Rate for Payer: Humana Medicare	$87.36
Rate for Payer: Kaiser Permanente Commercial	$157.26
Rate for Payer: Kaiser Permanente Medicaid	$89.11
Rate for Payer: Kaiser Permanente Medicare	$87.36
Rate for Payer: MDX Hawaii PPO	$169.49
Rate for Payer: Ohana Health Plan Medicaid	$87.36
Rate for Payer: Ohana Health Plan Medicare	$87.36
Rate for Payer: UnitedHealthcare Medicaid	$104.84
Rate for Payer: UnitedHealthcare Medicare	$87.36
Rate for Payer: University Health Alliance Commercial	$127.36

nystatin 100000 units/gm powder topical [HHSC]

Facility

OP

$115.46

Service Code	NDC 69315030615
Hospital Charge Code	2500596
Hospital Revenue Code	250
Min. Negotiated Rate	$57.73
Max. Negotiated Rate	$112.00
Rate for Payer: AlohaCare Medicaid	$57.73
Rate for Payer: AlohaCare Medicare	$57.73
Rate for Payer: Cash Price	$75.05
Rate for Payer: Devoted Health Medicare	$63.50
Rate for Payer: Hawaii Medical Service Association Medicare	$57.73
Rate for Payer: Hawaii Western Management Group Commercial	$109.69
Rate for Payer: Health Management Network Commercial	$98.14
Rate for Payer: Humana Medicare	$57.73
Rate for Payer: Kaiser Permanente Commercial	$103.91
Rate for Payer: Kaiser Permanente Medicaid	$58.88
Rate for Payer: Kaiser Permanente Medicare	$57.73
Rate for Payer: MDX Hawaii PPO	$112.00
Rate for Payer: Ohana Health Plan Medicaid	$57.73
Rate for Payer: Ohana Health Plan Medicare	$57.73
Rate for Payer: UnitedHealthcare Medicaid	$69.28
Rate for Payer: UnitedHealthcare Medicare	$57.73
Rate for Payer: University Health Alliance Commercial	$84.16

nystatin 100000 units/gm powder topical [HHSC]

Facility

IP

$132.93

Service Code	NDC 42543035215
Hospital Charge Code	2500596
Hospital Revenue Code	250
Min. Negotiated Rate	$112.99
Max. Negotiated Rate	$128.94
Rate for Payer: Cash Price	$86.40
Rate for Payer: Health Management Network Commercial	$112.99
Rate for Payer: Kaiser Permanente Commercial	$119.64
Rate for Payer: MDX Hawaii PPO	$128.94

nystatin 100000 units/gm powder topical [HHSC]

Facility

IP

$115.46

Service Code	NDC 69315030615
Hospital Charge Code	2500596
Hospital Revenue Code	250
Min. Negotiated Rate	$98.14
Max. Negotiated Rate	$112.00
Rate for Payer: Cash Price	$75.05
Rate for Payer: Health Management Network Commercial	$98.14
Rate for Payer: Kaiser Permanente Commercial	$103.91
Rate for Payer: MDX Hawaii PPO	$112.00

nystatin 100000 units/gm powder topical [HHSC]

Facility

IP

$135.19

Service Code	NDC 68382037001
Hospital Charge Code	2500596
Hospital Revenue Code	250
Min. Negotiated Rate	$114.91
Max. Negotiated Rate	$131.13
Rate for Payer: Cash Price	$87.87
Rate for Payer: Health Management Network Commercial	$114.91
Rate for Payer: Kaiser Permanente Commercial	$121.67
Rate for Payer: MDX Hawaii PPO	$131.13

nystatin 100000 units/gm powder topical [HHSC]

Facility

IP

$135.19

Service Code	NDC 42806018615
Hospital Charge Code	2500596
Hospital Revenue Code	250
Min. Negotiated Rate	$114.91
Max. Negotiated Rate	$131.13
Rate for Payer: Cash Price	$87.87
Rate for Payer: Health Management Network Commercial	$114.91
Rate for Payer: Kaiser Permanente Commercial	$121.67
Rate for Payer: MDX Hawaii PPO	$131.13

nystatin 100000 units/gm powder topical [HHSC]

Facility

OP

$135.19

Service Code	NDC 68382037001
Hospital Charge Code	2500596
Hospital Revenue Code	250
Min. Negotiated Rate	$67.59
Max. Negotiated Rate	$131.13
Rate for Payer: AlohaCare Medicaid	$67.59
Rate for Payer: AlohaCare Medicare	$67.59
Rate for Payer: Cash Price	$87.87
Rate for Payer: Devoted Health Medicare	$74.35
Rate for Payer: Hawaii Medical Service Association Medicare	$67.59
Rate for Payer: Hawaii Western Management Group Commercial	$128.43
Rate for Payer: Health Management Network Commercial	$114.91
Rate for Payer: Humana Medicare	$67.59
Rate for Payer: Kaiser Permanente Commercial	$121.67
Rate for Payer: Kaiser Permanente Medicaid	$68.95
Rate for Payer: Kaiser Permanente Medicare	$67.59
Rate for Payer: MDX Hawaii PPO	$131.13
Rate for Payer: Ohana Health Plan Medicaid	$67.59
Rate for Payer: Ohana Health Plan Medicare	$67.59
Rate for Payer: UnitedHealthcare Medicaid	$81.11
Rate for Payer: UnitedHealthcare Medicare	$67.59
Rate for Payer: University Health Alliance Commercial	$98.54

nystatin 100000 units/gm powder topical [HHSC]

Facility

OP

$132.93

Service Code	NDC 00574200815
Hospital Charge Code	2500596
Hospital Revenue Code	250
Min. Negotiated Rate	$66.47
Max. Negotiated Rate	$128.94
Rate for Payer: AlohaCare Medicaid	$66.47
Rate for Payer: AlohaCare Medicare	$66.47
Rate for Payer: Cash Price	$86.40
Rate for Payer: Devoted Health Medicare	$73.11
Rate for Payer: Hawaii Medical Service Association Medicare	$66.47
Rate for Payer: Hawaii Western Management Group Commercial	$126.28
Rate for Payer: Health Management Network Commercial	$112.99
Rate for Payer: Humana Medicare	$66.47
Rate for Payer: Kaiser Permanente Commercial	$119.64
Rate for Payer: Kaiser Permanente Medicaid	$67.79
Rate for Payer: Kaiser Permanente Medicare	$66.47
Rate for Payer: MDX Hawaii PPO	$128.94
Rate for Payer: Ohana Health Plan Medicaid	$66.47
Rate for Payer: Ohana Health Plan Medicare	$66.47
Rate for Payer: UnitedHealthcare Medicaid	$79.76
Rate for Payer: UnitedHealthcare Medicare	$66.47
Rate for Payer: University Health Alliance Commercial	$96.89

nystatin 100000 units/gm powder topical [HHSC]

Facility

OP

$135.19

Service Code	NDC 42806018615
Hospital Charge Code	2500596
Hospital Revenue Code	250
Min. Negotiated Rate	$67.59
Max. Negotiated Rate	$131.13
Rate for Payer: AlohaCare Medicaid	$67.59
Rate for Payer: AlohaCare Medicare	$67.59
Rate for Payer: Cash Price	$87.87
Rate for Payer: Devoted Health Medicare	$74.35
Rate for Payer: Hawaii Medical Service Association Medicare	$67.59
Rate for Payer: Hawaii Western Management Group Commercial	$128.43
Rate for Payer: Health Management Network Commercial	$114.91
Rate for Payer: Humana Medicare	$67.59
Rate for Payer: Kaiser Permanente Commercial	$121.67
Rate for Payer: Kaiser Permanente Medicaid	$68.95
Rate for Payer: Kaiser Permanente Medicare	$67.59
Rate for Payer: MDX Hawaii PPO	$131.13
Rate for Payer: Ohana Health Plan Medicaid	$67.59
Rate for Payer: Ohana Health Plan Medicare	$67.59
Rate for Payer: UnitedHealthcare Medicaid	$81.11
Rate for Payer: UnitedHealthcare Medicare	$67.59
Rate for Payer: University Health Alliance Commercial	$98.54

nystatin 100000 units/gm powder topical [HHSC]

Facility

IP

$91.47

Service Code	NDC 68308015215
Hospital Charge Code	2500596
Hospital Revenue Code	250
Min. Negotiated Rate	$77.75
Max. Negotiated Rate	$88.73
Rate for Payer: Cash Price	$59.46
Rate for Payer: Health Management Network Commercial	$77.75
Rate for Payer: Kaiser Permanente Commercial	$82.32
Rate for Payer: MDX Hawaii PPO	$88.73

nystatin 100000 units/gm powder topical [HHSC]

Facility

IP

$132.93

Service Code	NDC 00574200815
Hospital Charge Code	2500596
Hospital Revenue Code	250
Min. Negotiated Rate	$112.99
Max. Negotiated Rate	$128.94
Rate for Payer: Cash Price	$86.40
Rate for Payer: Health Management Network Commercial	$112.99
Rate for Payer: Kaiser Permanente Commercial	$119.64
Rate for Payer: MDX Hawaii PPO	$128.94

nystatin 100000 units/gm powder topical [HHSC]

Facility

OP

$91.47

Service Code	NDC 68308015215
Hospital Charge Code	2500596
Hospital Revenue Code	250
Min. Negotiated Rate	$45.73
Max. Negotiated Rate	$88.73
Rate for Payer: AlohaCare Medicaid	$45.73
Rate for Payer: AlohaCare Medicare	$45.73
Rate for Payer: Cash Price	$59.46
Rate for Payer: Devoted Health Medicare	$50.31
Rate for Payer: Hawaii Medical Service Association Medicare	$45.73
Rate for Payer: Hawaii Western Management Group Commercial	$86.90
Rate for Payer: Health Management Network Commercial	$77.75
Rate for Payer: Humana Medicare	$45.73
Rate for Payer: Kaiser Permanente Commercial	$82.32
Rate for Payer: Kaiser Permanente Medicaid	$46.65
Rate for Payer: Kaiser Permanente Medicare	$45.73
Rate for Payer: MDX Hawaii PPO	$88.73
Rate for Payer: Ohana Health Plan Medicaid	$45.73
Rate for Payer: Ohana Health Plan Medicare	$45.73
Rate for Payer: UnitedHealthcare Medicaid	$54.88
Rate for Payer: UnitedHealthcare Medicare	$45.73
Rate for Payer: University Health Alliance Commercial	$66.67

nystatin 100000 units/gm powder topical [HHSC]

Facility

OP

$132.93

Service Code	NDC 42543005261
Hospital Charge Code	2500596
Hospital Revenue Code	250
Min. Negotiated Rate	$66.47
Max. Negotiated Rate	$128.94
Rate for Payer: AlohaCare Medicaid	$66.47
Rate for Payer: AlohaCare Medicare	$66.47
Rate for Payer: Cash Price	$86.40
Rate for Payer: Devoted Health Medicare	$73.11
Rate for Payer: Hawaii Medical Service Association Medicare	$66.47
Rate for Payer: Hawaii Western Management Group Commercial	$126.28
Rate for Payer: Health Management Network Commercial	$112.99
Rate for Payer: Humana Medicare	$66.47
Rate for Payer: Kaiser Permanente Commercial	$119.64
Rate for Payer: Kaiser Permanente Medicaid	$67.79
Rate for Payer: Kaiser Permanente Medicare	$66.47
Rate for Payer: MDX Hawaii PPO	$128.94
Rate for Payer: Ohana Health Plan Medicaid	$66.47
Rate for Payer: Ohana Health Plan Medicare	$66.47
Rate for Payer: UnitedHealthcare Medicaid	$79.76
Rate for Payer: UnitedHealthcare Medicare	$66.47
Rate for Payer: University Health Alliance Commercial	$96.89

nystatin 100000 units/gm powder topical [HHSC]

Facility

OP

$132.93

Service Code	NDC 42543035215
Hospital Charge Code	2500596
Hospital Revenue Code	250
Min. Negotiated Rate	$66.47
Max. Negotiated Rate	$128.94
Rate for Payer: AlohaCare Medicaid	$66.47
Rate for Payer: AlohaCare Medicare	$66.47
Rate for Payer: Cash Price	$86.40
Rate for Payer: Devoted Health Medicare	$73.11
Rate for Payer: Hawaii Medical Service Association Medicare	$66.47
Rate for Payer: Hawaii Western Management Group Commercial	$126.28
Rate for Payer: Health Management Network Commercial	$112.99
Rate for Payer: Humana Medicare	$66.47
Rate for Payer: Kaiser Permanente Commercial	$119.64
Rate for Payer: Kaiser Permanente Medicaid	$67.79
Rate for Payer: Kaiser Permanente Medicare	$66.47
Rate for Payer: MDX Hawaii PPO	$128.94
Rate for Payer: Ohana Health Plan Medicaid	$66.47
Rate for Payer: Ohana Health Plan Medicare	$66.47
Rate for Payer: UnitedHealthcare Medicaid	$79.76
Rate for Payer: UnitedHealthcare Medicare	$66.47
Rate for Payer: University Health Alliance Commercial	$96.89

nystatin 100,000 units/mL 5 mL U/D oral susp [HHSC]

Facility

OP

$12.60

Service Code	NDC 00121086800
Hospital Charge Code	2501145
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$12.22
Rate for Payer: AlohaCare Medicaid	$6.30
Rate for Payer: AlohaCare Medicare	$6.30
Rate for Payer: Cash Price	$8.19
Rate for Payer: Devoted Health Medicare	$6.93
Rate for Payer: Hawaii Medical Service Association Medicare	$6.30
Rate for Payer: Hawaii Western Management Group Commercial	$11.97
Rate for Payer: Health Management Network Commercial	$10.71
Rate for Payer: Humana Medicare	$6.30
Rate for Payer: Kaiser Permanente Commercial	$11.34
Rate for Payer: Kaiser Permanente Medicaid	$6.43
Rate for Payer: Kaiser Permanente Medicare	$6.30
Rate for Payer: MDX Hawaii PPO	$12.22
Rate for Payer: Ohana Health Plan Medicaid	$6.30
Rate for Payer: Ohana Health Plan Medicare	$6.30
Rate for Payer: UnitedHealthcare Medicaid	$7.56
Rate for Payer: UnitedHealthcare Medicare	$6.30
Rate for Payer: University Health Alliance Commercial	$9.18

nystatin 100,000 units/mL 5 mL U/D oral susp [HHSC]

Facility

IP

$12.60

Service Code	NDC 00121086800
Hospital Charge Code	2501145
Hospital Revenue Code	250
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$12.22
Rate for Payer: Cash Price	$8.19
Rate for Payer: Health Management Network Commercial	$10.71
Rate for Payer: Kaiser Permanente Commercial	$11.34
Rate for Payer: MDX Hawaii PPO	$12.22

nystatin 100000 units/ml 60ml [HHSC]

Facility

IP

$78.34

Service Code	NDC 00121081002
Hospital Charge Code	2500594
Hospital Revenue Code	250
Min. Negotiated Rate	$66.59
Max. Negotiated Rate	$75.99
Rate for Payer: Cash Price	$50.92
Rate for Payer: Health Management Network Commercial	$66.59
Rate for Payer: Kaiser Permanente Commercial	$70.51
Rate for Payer: MDX Hawaii PPO	$75.99

nystatin 100000 units/ml 60ml [HHSC]

Facility

OP

$78.34

Service Code	NDC 00121081002
Hospital Charge Code	2500594
Hospital Revenue Code	250
Min. Negotiated Rate	$39.17
Max. Negotiated Rate	$75.99
Rate for Payer: AlohaCare Medicaid	$39.17
Rate for Payer: AlohaCare Medicare	$39.17
Rate for Payer: Cash Price	$50.92
Rate for Payer: Devoted Health Medicare	$43.09
Rate for Payer: Hawaii Medical Service Association Medicare	$39.17
Rate for Payer: Hawaii Western Management Group Commercial	$74.42
Rate for Payer: Health Management Network Commercial	$66.59
Rate for Payer: Humana Medicare	$39.17
Rate for Payer: Kaiser Permanente Commercial	$70.51
Rate for Payer: Kaiser Permanente Medicaid	$39.95
Rate for Payer: Kaiser Permanente Medicare	$39.17
Rate for Payer: MDX Hawaii PPO	$75.99
Rate for Payer: Ohana Health Plan Medicaid	$39.17
Rate for Payer: Ohana Health Plan Medicare	$39.17
Rate for Payer: UnitedHealthcare Medicaid	$47.00
Rate for Payer: UnitedHealthcare Medicare	$39.17
Rate for Payer: University Health Alliance Commercial	$57.10

nystatin 100000 units/ml 60ml [HHSC]

Facility

OP

$78.34

Service Code	NDC 66689000802
Hospital Charge Code	2500594
Hospital Revenue Code	250
Min. Negotiated Rate	$39.17
Max. Negotiated Rate	$75.99
Rate for Payer: AlohaCare Medicaid	$39.17
Rate for Payer: AlohaCare Medicare	$39.17
Rate for Payer: Cash Price	$50.92
Rate for Payer: Devoted Health Medicare	$43.09
Rate for Payer: Hawaii Medical Service Association Medicare	$39.17
Rate for Payer: Hawaii Western Management Group Commercial	$74.42
Rate for Payer: Health Management Network Commercial	$66.59
Rate for Payer: Humana Medicare	$39.17
Rate for Payer: Kaiser Permanente Commercial	$70.51
Rate for Payer: Kaiser Permanente Medicaid	$39.95
Rate for Payer: Kaiser Permanente Medicare	$39.17
Rate for Payer: MDX Hawaii PPO	$75.99
Rate for Payer: Ohana Health Plan Medicaid	$39.17
Rate for Payer: Ohana Health Plan Medicare	$39.17
Rate for Payer: UnitedHealthcare Medicaid	$47.00
Rate for Payer: UnitedHealthcare Medicare	$39.17
Rate for Payer: University Health Alliance Commercial	$57.10

nystatin 100000 units/ml 60ml [HHSC]

Facility

OP

$78.34

Service Code	NDC 00121086802
Hospital Charge Code	2500594
Hospital Revenue Code	250
Min. Negotiated Rate	$39.17
Max. Negotiated Rate	$75.99
Rate for Payer: AlohaCare Medicaid	$39.17
Rate for Payer: AlohaCare Medicare	$39.17
Rate for Payer: Cash Price	$50.92
Rate for Payer: Devoted Health Medicare	$43.09
Rate for Payer: Hawaii Medical Service Association Medicare	$39.17
Rate for Payer: Hawaii Western Management Group Commercial	$74.42
Rate for Payer: Health Management Network Commercial	$66.59
Rate for Payer: Humana Medicare	$39.17
Rate for Payer: Kaiser Permanente Commercial	$70.51
Rate for Payer: Kaiser Permanente Medicaid	$39.95
Rate for Payer: Kaiser Permanente Medicare	$39.17
Rate for Payer: MDX Hawaii PPO	$75.99
Rate for Payer: Ohana Health Plan Medicaid	$39.17
Rate for Payer: Ohana Health Plan Medicare	$39.17
Rate for Payer: UnitedHealthcare Medicaid	$47.00
Rate for Payer: UnitedHealthcare Medicare	$39.17
Rate for Payer: University Health Alliance Commercial	$57.10

nystatin 100000 units/ml 60ml [HHSC]

Facility

IP

$88.96

Service Code	NDC 60432053760
Hospital Charge Code	2500594
Hospital Revenue Code	250
Min. Negotiated Rate	$75.62
Max. Negotiated Rate	$86.29
Rate for Payer: Cash Price	$57.82
Rate for Payer: Health Management Network Commercial	$75.62
Rate for Payer: Kaiser Permanente Commercial	$80.06
Rate for Payer: MDX Hawaii PPO	$86.29

nystatin 100000 units/ml 60ml [HHSC]

Facility

IP

$78.34

Service Code	NDC 66689000802
Hospital Charge Code	2500594
Hospital Revenue Code	250
Min. Negotiated Rate	$66.59
Max. Negotiated Rate	$75.99
Rate for Payer: Cash Price	$50.92
Rate for Payer: Health Management Network Commercial	$66.59
Rate for Payer: Kaiser Permanente Commercial	$70.51
Rate for Payer: MDX Hawaii PPO	$75.99

nystatin 100000 units/ml 60ml [HHSC]

Facility

IP

$78.34

Service Code	NDC 00121086802
Hospital Charge Code	2500594
Hospital Revenue Code	250
Min. Negotiated Rate	$66.59
Max. Negotiated Rate	$75.99
Rate for Payer: Cash Price	$50.92
Rate for Payer: Health Management Network Commercial	$66.59
Rate for Payer: Kaiser Permanente Commercial	$70.51
Rate for Payer: MDX Hawaii PPO	$75.99

<<
<
362
363
364
365
366
367
368
369
370
371
>
>>