Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

OP

$4.00

Service Code	NDC 43598043611
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

OP

$4.00

Service Code	NDC 68462063925
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

OP

$2.00

Service Code	NDC 68462063901
Hospital Revenue Code	637
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.26
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: University Health Alliance Commercial	$1.46

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

OP

$4.00

Service Code	NDC 59762330403
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

OP

$4.00

Service Code	NDC 68462063945
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

NITROGLYCERIN 1000 MCG/10 ML SYRINGE (SIMPLE) [4080323]

Facility

OP

$2.00

Service Code	HCPCS J2305
Hospital Revenue Code	636
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Cash Price	$1.20
Rate for Payer: Hawaii Medical Service Association ABD	$1.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.42
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.26
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: UnitedHealthcare Medicaid	$1.20
Rate for Payer: University Health Alliance Commercial	$1.46

NITROGLYCERIN 1000 MCG/10 ML SYRINGE (SIMPLE) [4080323]

Facility

IP

$2.00

Service Code	HCPCS J2305
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: MDX Hawaii PPO	$1.94

NITROGLYCERIN 2 % TRANSDERMAL OINTMENT [5606]

Facility

OP

$11.00

Service Code	NDC 00281032608
Hospital Revenue Code	637
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Hawaii Western Management Group Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Kaiser Permanente Commercial	$6.93
Rate for Payer: Kaiser Permanente Medicaid	$5.61
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: University Health Alliance Commercial	$8.02

NITROGLYCERIN 2 % TRANSDERMAL OINTMENT [5606]

Facility

IP

$11.00

Service Code	NDC 00281032608
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: MDX Hawaii PPO	$10.67

NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL [27096]

Facility

OP

$562.00

Service Code	NDC 45802021001
Hospital Revenue Code	637
Min. Negotiated Rate	$286.62
Max. Negotiated Rate	$545.14
Rate for Payer: Cash Price	$337.20
Rate for Payer: Hawaii Western Management Group Commercial	$533.90
Rate for Payer: Health Management Network Commercial	$477.70
Rate for Payer: Kaiser Permanente Commercial	$354.06
Rate for Payer: Kaiser Permanente Medicaid	$286.62
Rate for Payer: MDX Hawaii PPO	$545.14
Rate for Payer: University Health Alliance Commercial	$409.64

NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL [27096]

Facility

IP

$562.00

Service Code	NDC 45802021001
Hospital Revenue Code	250
Min. Negotiated Rate	$477.70
Max. Negotiated Rate	$545.14
Rate for Payer: Cash Price	$337.20
Rate for Payer: Health Management Network Commercial	$477.70
Rate for Payer: MDX Hawaii PPO	$545.14

NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [5599]

Facility

OP

$66.00

Service Code	HCPCS J2305
Hospital Revenue Code	636
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cash Price	$39.60
Rate for Payer: Hawaii Medical Service Association ABD	$1.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.42
Rate for Payer: Hawaii Western Management Group Commercial	$62.70
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Kaiser Permanente Commercial	$41.58
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: UnitedHealthcare Medicaid	$39.60
Rate for Payer: University Health Alliance Commercial	$48.11

NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [5599]

Facility

IP

$66.00

Service Code	HCPCS J2305
Hospital Revenue Code	250
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$39.60
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: MDX Hawaii PPO	$64.02

NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS [15859]

Facility

IP

$99.00

Service Code	HCPCS J2305
Hospital Revenue Code	250
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$59.40
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: MDX Hawaii PPO	$96.03

NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS [15859]

Facility

OP

$99.00

Service Code	HCPCS J2305
Hospital Revenue Code	636
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$96.03
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cash Price	$59.40
Rate for Payer: Hawaii Medical Service Association ABD	$1.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.42
Rate for Payer: Hawaii Western Management Group Commercial	$94.05
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Kaiser Permanente Commercial	$62.37
Rate for Payer: Kaiser Permanente Medicaid	$50.49
Rate for Payer: MDX Hawaii PPO	$96.03
Rate for Payer: UnitedHealthcare Medicaid	$59.40
Rate for Payer: University Health Alliance Commercial	$72.16

NITROGLYCERIN TABLETS (#25) (NITROSTAT) 0.4 MG (TAKE HOME) [4080381]

Facility

IP

$15.00

Service Code	NDC 00004080169
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: MDX Hawaii PPO	$14.55

NITROGLYCERIN TABLETS (#25) (NITROSTAT) 0.4 MG (TAKE HOME) [4080381]

Facility

OP

$15.00

Service Code	NDC 00004080169
Hospital Revenue Code	253
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: University Health Alliance Commercial	$10.93

NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION [127844]

Facility

OP

$5,958.00

Service Code	HCPCS J9299
Hospital Revenue Code	636
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$5,779.26
Rate for Payer: AlohaCare Medicaid	$33.62
Rate for Payer: AlohaCare Medicare	$33.62
Rate for Payer: Cash Price	$3,574.80
Rate for Payer: Cash Price	$3,574.80
Rate for Payer: Devoted Health Medicare	$36.98
Rate for Payer: Hawaii Medical Service Association ABD	$33.00
Rate for Payer: Hawaii Medical Service Association Commercial	$42.02
Rate for Payer: Hawaii Medical Service Association Medicare	$33.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,660.10
Rate for Payer: Health Management Network Commercial	$5,064.30
Rate for Payer: Humana Medicare	$33.62
Rate for Payer: Kaiser Permanente Commercial	$3,753.54
Rate for Payer: Kaiser Permanente Medicaid	$3,038.58
Rate for Payer: Kaiser Permanente Medicare	$33.62
Rate for Payer: MDX Hawaii PPO	$5,779.26
Rate for Payer: Ohana Health Plan Medicaid	$36.98
Rate for Payer: Ohana Health Plan Medicare	$33.62
Rate for Payer: UnitedHealthcare Medicaid	$3,574.80
Rate for Payer: UnitedHealthcare Medicare	$33.62
Rate for Payer: University Health Alliance Commercial	$4,342.79

NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION [127844]

Facility

IP

$5,958.00

Service Code	HCPCS J9299
Hospital Revenue Code	250
Min. Negotiated Rate	$5,064.30
Max. Negotiated Rate	$5,779.26
Rate for Payer: Cash Price	$3,574.80
Rate for Payer: Health Management Network Commercial	$5,064.30
Rate for Payer: MDX Hawaii PPO	$5,779.26

NIVOLUMAB 120 MG/12 ML INTRAVENOUS SOLUTION [181183]

Facility

IP

$7,149.00

Service Code	HCPCS J9299
Hospital Revenue Code	250
Min. Negotiated Rate	$6,076.65
Max. Negotiated Rate	$6,934.53
Rate for Payer: Cash Price	$4,289.40
Rate for Payer: Health Management Network Commercial	$6,076.65
Rate for Payer: MDX Hawaii PPO	$6,934.53

NIVOLUMAB 120 MG/12 ML INTRAVENOUS SOLUTION [181183]

Facility

OP

$7,149.00

Service Code	HCPCS J9299
Hospital Revenue Code	636
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$6,934.53
Rate for Payer: AlohaCare Medicaid	$33.62
Rate for Payer: AlohaCare Medicare	$33.62
Rate for Payer: Cash Price	$4,289.40
Rate for Payer: Cash Price	$4,289.40
Rate for Payer: Devoted Health Medicare	$36.98
Rate for Payer: Hawaii Medical Service Association ABD	$33.00
Rate for Payer: Hawaii Medical Service Association Commercial	$42.02
Rate for Payer: Hawaii Medical Service Association Medicare	$33.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,791.55
Rate for Payer: Health Management Network Commercial	$6,076.65
Rate for Payer: Humana Medicare	$33.62
Rate for Payer: Kaiser Permanente Commercial	$4,503.87
Rate for Payer: Kaiser Permanente Medicaid	$3,645.99
Rate for Payer: Kaiser Permanente Medicare	$33.62
Rate for Payer: MDX Hawaii PPO	$6,934.53
Rate for Payer: Ohana Health Plan Medicaid	$36.98
Rate for Payer: Ohana Health Plan Medicare	$33.62
Rate for Payer: UnitedHealthcare Medicaid	$4,289.40
Rate for Payer: UnitedHealthcare Medicare	$33.62
Rate for Payer: University Health Alliance Commercial	$5,210.91

NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [151108]

Facility

IP

$14,298.00

Service Code	HCPCS J9299
Hospital Revenue Code	250
Min. Negotiated Rate	$12,153.30
Max. Negotiated Rate	$13,869.06
Rate for Payer: Cash Price	$8,578.80
Rate for Payer: Cash Price	$1,537.20
Rate for Payer: Health Management Network Commercial	$12,153.30
Rate for Payer: Health Management Network Commercial	$2,177.70
Rate for Payer: MDX Hawaii PPO	$13,869.06
Rate for Payer: MDX Hawaii PPO	$2,485.14

NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [151108]

Facility

OP

$2,562.00

Service Code	HCPCS J9299
Hospital Revenue Code	636
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$2,485.14
Rate for Payer: AlohaCare Medicaid	$33.62
Rate for Payer: AlohaCare Medicaid	$33.62
Rate for Payer: AlohaCare Medicare	$33.62
Rate for Payer: AlohaCare Medicare	$33.62
Rate for Payer: Cash Price	$1,537.20
Rate for Payer: Cash Price	$1,537.20
Rate for Payer: Cash Price	$8,578.80
Rate for Payer: Cash Price	$8,578.80
Rate for Payer: Devoted Health Medicare	$36.98
Rate for Payer: Devoted Health Medicare	$36.98
Rate for Payer: Hawaii Medical Service Association ABD	$33.00
Rate for Payer: Hawaii Medical Service Association ABD	$33.00
Rate for Payer: Hawaii Medical Service Association Commercial	$42.02
Rate for Payer: Hawaii Medical Service Association Commercial	$42.02
Rate for Payer: Hawaii Medical Service Association Medicare	$33.62
Rate for Payer: Hawaii Medical Service Association Medicare	$33.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33.00
Rate for Payer: Hawaii Western Management Group Commercial	$13,583.10
Rate for Payer: Hawaii Western Management Group Commercial	$2,433.90
Rate for Payer: Health Management Network Commercial	$12,153.30
Rate for Payer: Health Management Network Commercial	$2,177.70
Rate for Payer: Humana Medicare	$33.62
Rate for Payer: Humana Medicare	$33.62
Rate for Payer: Kaiser Permanente Commercial	$9,007.74
Rate for Payer: Kaiser Permanente Commercial	$1,614.06
Rate for Payer: Kaiser Permanente Medicaid	$1,306.62
Rate for Payer: Kaiser Permanente Medicaid	$7,291.98
Rate for Payer: Kaiser Permanente Medicare	$33.62
Rate for Payer: Kaiser Permanente Medicare	$33.62
Rate for Payer: MDX Hawaii PPO	$2,485.14
Rate for Payer: MDX Hawaii PPO	$13,869.06
Rate for Payer: Ohana Health Plan Medicaid	$36.98
Rate for Payer: Ohana Health Plan Medicaid	$36.98
Rate for Payer: Ohana Health Plan Medicare	$33.62
Rate for Payer: Ohana Health Plan Medicare	$33.62
Rate for Payer: UnitedHealthcare Medicaid	$1,537.20
Rate for Payer: UnitedHealthcare Medicaid	$8,578.80
Rate for Payer: UnitedHealthcare Medicare	$33.62
Rate for Payer: UnitedHealthcare Medicare	$33.62
Rate for Payer: University Health Alliance Commercial	$1,867.44
Rate for Payer: University Health Alliance Commercial	$10,421.81

NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [184158]

Facility

IP

$27,760.00

Service Code	HCPCS J9298
Hospital Revenue Code	250
Min. Negotiated Rate	$23,596.00
Max. Negotiated Rate	$26,927.20
Rate for Payer: Cash Price	$16,656.00
Rate for Payer: Health Management Network Commercial	$23,596.00
Rate for Payer: MDX Hawaii PPO	$26,927.20

NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [127843]

Facility

IP

$2,383.00

Service Code	HCPCS J9299
Hospital Revenue Code	250
Min. Negotiated Rate	$2,025.55
Max. Negotiated Rate	$2,311.51
Rate for Payer: Cash Price	$1,429.80
Rate for Payer: Health Management Network Commercial	$2,025.55
Rate for Payer: MDX Hawaii PPO	$2,311.51

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