Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH [27474]

Facility

OP

$8.00

Service Code	NDC 00378911216
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

NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH [27474]

Facility

OP

$8.00

Service Code	NDC 00378911293
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

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

OP

$4.00

Service Code	NDC 68462063925
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$3.04
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3.04
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$3.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$3.04
Rate for Payer: Ohana Health Plan Medicare	$3.04
Rate for Payer: UnitedHealthcare Medicare	$3.04
Rate for Payer: University Health Alliance Commercial	$2.92

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

IP

$4.00

Service Code	NDC 68462063945
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

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

IP

$4.00

Service Code	NDC 43598043611
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

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

IP

$2.00

Service Code	NDC 68462063901
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: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

IP

$4.00

Service Code	NDC 59762330403
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

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

OP

$4.00

Service Code	NDC 68462063945
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$3.04
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3.04
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$3.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$3.04
Rate for Payer: Ohana Health Plan Medicare	$3.04
Rate for Payer: UnitedHealthcare Medicare	$3.04
Rate for Payer: University Health Alliance Commercial	$2.92

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

OP

$4.00

Service Code	NDC 43598043611
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$3.04
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3.04
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$3.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$3.04
Rate for Payer: Ohana Health Plan Medicare	$3.04
Rate for Payer: UnitedHealthcare Medicare	$3.04
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	$1.00
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$1.52
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.52
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$1.52
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$1.52
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$1.52
Rate for Payer: Ohana Health Plan Medicare	$1.52
Rate for Payer: UnitedHealthcare Medicare	$1.52
Rate for Payer: University Health Alliance Commercial	$1.46

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

IP

$4.00

Service Code	NDC 68462063925
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

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET [5604]

Facility

OP

$4.00

Service Code	NDC 59762330403
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$3.04
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3.04
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$3.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$3.04
Rate for Payer: Ohana Health Plan Medicare	$3.04
Rate for Payer: UnitedHealthcare Medicare	$3.04
Rate for Payer: University Health Alliance Commercial	$2.92

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: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

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

Facility

OP

$2.00

Service Code	HCPCS J2305
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$1.52
Rate for Payer: Cash Price	$1.20
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association ABD	$1.42
Rate for Payer: Hawaii Medical Service Association Medicare	$1.52
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: Humana Medicare	$1.52
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$1.52
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$1.52
Rate for Payer: Ohana Health Plan Medicare	$1.52
Rate for Payer: UnitedHealthcare Medicaid	$1.20
Rate for Payer: UnitedHealthcare Medicare	$1.52
Rate for Payer: University Health Alliance Commercial	$1.46

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: Kaiser Permanente Commercial	$9.90
Rate for Payer: MDX Hawaii PPO	$10.67

NITROGLYCERIN 2 % TRANSDERMAL OINTMENT [5606]

Facility

OP

$11.00

Service Code	NDC 00281032608
Hospital Revenue Code	637
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$10.67
Rate for Payer: AlohaCare Medicaid	$5.50
Rate for Payer: AlohaCare Medicare	$8.36
Rate for Payer: Cash Price	$6.60
Rate for Payer: Devoted Health Medicare	$9.24
Rate for Payer: Hawaii Medical Service Association Medicare	$8.36
Rate for Payer: Hawaii Western Management Group Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Humana Medicare	$8.36
Rate for Payer: Kaiser Permanente Commercial	$9.90
Rate for Payer: Kaiser Permanente Medicaid	$5.61
Rate for Payer: Kaiser Permanente Medicare	$8.36
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: Ohana Health Plan Medicaid	$8.36
Rate for Payer: Ohana Health Plan Medicare	$8.36
Rate for Payer: UnitedHealthcare Medicare	$8.36
Rate for Payer: University Health Alliance Commercial	$8.02

NITROGLYCERIN 400 MCG/SPRAY TRANSLINGUAL [27096]

Facility

OP

$562.00

Service Code	NDC 45802021001
Hospital Revenue Code	637
Min. Negotiated Rate	$281.00
Max. Negotiated Rate	$545.14
Rate for Payer: AlohaCare Medicaid	$281.00
Rate for Payer: AlohaCare Medicare	$427.12
Rate for Payer: Cash Price	$337.20
Rate for Payer: Devoted Health Medicare	$472.08
Rate for Payer: Hawaii Medical Service Association Medicare	$427.12
Rate for Payer: Hawaii Western Management Group Commercial	$533.90
Rate for Payer: Health Management Network Commercial	$477.70
Rate for Payer: Humana Medicare	$427.12
Rate for Payer: Kaiser Permanente Commercial	$505.80
Rate for Payer: Kaiser Permanente Medicaid	$286.62
Rate for Payer: Kaiser Permanente Medicare	$427.12
Rate for Payer: MDX Hawaii PPO	$545.14
Rate for Payer: Ohana Health Plan Medicaid	$427.12
Rate for Payer: Ohana Health Plan Medicare	$427.12
Rate for Payer: UnitedHealthcare Medicare	$427.12
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: Kaiser Permanente Commercial	$505.80
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: AlohaCare Medicaid	$33.00
Rate for Payer: AlohaCare Medicare	$50.16
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cash Price	$39.60
Rate for Payer: Devoted Health Medicare	$55.44
Rate for Payer: Hawaii Medical Service Association ABD	$1.42
Rate for Payer: Hawaii Medical Service Association Medicare	$50.16
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: Humana Medicare	$50.16
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: Kaiser Permanente Medicare	$50.16
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: Ohana Health Plan Medicaid	$50.16
Rate for Payer: Ohana Health Plan Medicare	$50.16
Rate for Payer: UnitedHealthcare Medicaid	$39.60
Rate for Payer: UnitedHealthcare Medicare	$50.16
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: Kaiser Permanente Commercial	$59.40
Rate for Payer: MDX Hawaii PPO	$64.02

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: AlohaCare Medicaid	$49.50
Rate for Payer: AlohaCare Medicare	$75.24
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cash Price	$59.40
Rate for Payer: Devoted Health Medicare	$83.16
Rate for Payer: Hawaii Medical Service Association ABD	$1.42
Rate for Payer: Hawaii Medical Service Association Medicare	$75.24
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: Humana Medicare	$75.24
Rate for Payer: Kaiser Permanente Commercial	$89.10
Rate for Payer: Kaiser Permanente Medicaid	$50.49
Rate for Payer: Kaiser Permanente Medicare	$75.24
Rate for Payer: MDX Hawaii PPO	$96.03
Rate for Payer: Ohana Health Plan Medicaid	$75.24
Rate for Payer: Ohana Health Plan Medicare	$75.24
Rate for Payer: UnitedHealthcare Medicaid	$59.40
Rate for Payer: UnitedHealthcare Medicare	$75.24
Rate for Payer: University Health Alliance Commercial	$72.16

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: Kaiser Permanente Commercial	$89.10
Rate for Payer: MDX Hawaii PPO	$96.03

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: Kaiser Permanente Commercial	$13.50
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	$7.50
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$11.40
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$12.60
Rate for Payer: Hawaii Medical Service Association Medicare	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$11.40
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$11.40
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$11.40
Rate for Payer: Ohana Health Plan Medicare	$11.40
Rate for Payer: UnitedHealthcare Medicare	$11.40
Rate for Payer: University Health Alliance Commercial	$10.93

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: Kaiser Permanente Commercial	$5,362.20
Rate for Payer: MDX Hawaii PPO	$5,779.26

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