Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION [127844]

Facility

$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

NIVOLUMAB 120 MG/12 ML INTRAVENOUS SOLUTION [181183]

Facility

$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	$3,574.50
Rate for Payer: AlohaCare Medicare	$5,433.24
Rate for Payer: Cash Price	$4,289.40
Rate for Payer: Cash Price	$4,289.40
Rate for Payer: Devoted Health Medicare	$6,005.16
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	$5,433.24
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	$5,433.24
Rate for Payer: Kaiser Permanente Commercial	$6,434.10
Rate for Payer: Kaiser Permanente Medicaid	$3,645.99
Rate for Payer: Kaiser Permanente Medicare	$5,433.24
Rate for Payer: MDX Hawaii PPO	$6,934.53
Rate for Payer: Ohana Health Plan Medicaid	$5,433.24
Rate for Payer: Ohana Health Plan Medicare	$5,433.24
Rate for Payer: UnitedHealthcare Medicaid	$4,289.40
Rate for Payer: UnitedHealthcare Medicare	$5,433.24
Rate for Payer: University Health Alliance Commercial	$5,210.91

NIVOLUMAB 120 MG/12 ML INTRAVENOUS SOLUTION [181183]

Facility

$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: Kaiser Permanente Commercial	$6,434.10
Rate for Payer: MDX Hawaii PPO	$6,934.53

NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [151108]

Facility

$14,298.00

Service Code	HCPCS J9299
Hospital Revenue Code	636
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$13,869.06
Rate for Payer: AlohaCare Medicaid	$7,149.00
Rate for Payer: AlohaCare Medicaid	$1,281.00
Rate for Payer: AlohaCare Medicare	$1,947.12
Rate for Payer: AlohaCare Medicare	$10,866.48
Rate for Payer: Cash Price	$1,537.20
Rate for Payer: Cash Price	$8,578.80
Rate for Payer: Cash Price	$1,537.20
Rate for Payer: Cash Price	$8,578.80
Rate for Payer: Devoted Health Medicare	$12,010.32
Rate for Payer: Devoted Health Medicare	$2,152.08
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	$1,947.12
Rate for Payer: Hawaii Medical Service Association Medicare	$10,866.48
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	$2,177.70
Rate for Payer: Health Management Network Commercial	$12,153.30
Rate for Payer: Humana Medicare	$10,866.48
Rate for Payer: Humana Medicare	$1,947.12
Rate for Payer: Kaiser Permanente Commercial	$12,868.20
Rate for Payer: Kaiser Permanente Commercial	$2,305.80
Rate for Payer: Kaiser Permanente Medicaid	$1,306.62
Rate for Payer: Kaiser Permanente Medicaid	$7,291.98
Rate for Payer: Kaiser Permanente Medicare	$10,866.48
Rate for Payer: Kaiser Permanente Medicare	$1,947.12
Rate for Payer: MDX Hawaii PPO	$13,869.06
Rate for Payer: MDX Hawaii PPO	$2,485.14
Rate for Payer: Ohana Health Plan Medicaid	$1,947.12
Rate for Payer: Ohana Health Plan Medicaid	$10,866.48
Rate for Payer: Ohana Health Plan Medicare	$10,866.48
Rate for Payer: Ohana Health Plan Medicare	$1,947.12
Rate for Payer: UnitedHealthcare Medicaid	$1,537.20
Rate for Payer: UnitedHealthcare Medicaid	$8,578.80
Rate for Payer: UnitedHealthcare Medicare	$10,866.48
Rate for Payer: UnitedHealthcare Medicare	$1,947.12
Rate for Payer: University Health Alliance Commercial	$10,421.81
Rate for Payer: University Health Alliance Commercial	$1,867.44

NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [151108]

Facility

$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: Kaiser Permanente Commercial	$12,868.20
Rate for Payer: Kaiser Permanente Commercial	$2,305.80
Rate for Payer: MDX Hawaii PPO	$2,485.14
Rate for Payer: MDX Hawaii PPO	$13,869.06

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

Facility

$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: Kaiser Permanente Commercial	$24,984.00
Rate for Payer: MDX Hawaii PPO	$26,927.20

NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [127843]

Facility

$2,383.00

Service Code	HCPCS J9299
Hospital Revenue Code	636
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$2,311.51
Rate for Payer: AlohaCare Medicaid	$1,191.50
Rate for Payer: AlohaCare Medicare	$1,811.08
Rate for Payer: Cash Price	$1,429.80
Rate for Payer: Cash Price	$1,429.80
Rate for Payer: Devoted Health Medicare	$2,001.72
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	$1,811.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,263.85
Rate for Payer: Health Management Network Commercial	$2,025.55
Rate for Payer: Humana Medicare	$1,811.08
Rate for Payer: Kaiser Permanente Commercial	$2,144.70
Rate for Payer: Kaiser Permanente Medicaid	$1,215.33
Rate for Payer: Kaiser Permanente Medicare	$1,811.08
Rate for Payer: MDX Hawaii PPO	$2,311.51
Rate for Payer: Ohana Health Plan Medicaid	$1,811.08
Rate for Payer: Ohana Health Plan Medicare	$1,811.08
Rate for Payer: UnitedHealthcare Medicaid	$1,429.80
Rate for Payer: UnitedHealthcare Medicare	$1,811.08
Rate for Payer: University Health Alliance Commercial	$1,736.97

NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [127843]

Facility

$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: Kaiser Permanente Commercial	$2,144.70
Rate for Payer: MDX Hawaii PPO	$2,311.51

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC

Facility

$37,543.97

Service Code	MSDRG 098
Min. Negotiated Rate	$37,543.97
Max. Negotiated Rate	$37,543.97
Rate for Payer: Hawaii Medical Service Association Commercial	$37,543.97

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC

Facility

$37,543.97

Service Code	MSDRG 097
Min. Negotiated Rate	$37,543.97
Max. Negotiated Rate	$37,543.97
Rate for Payer: Hawaii Medical Service Association Commercial	$37,543.97

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$37,543.97

Service Code	MSDRG 099
Min. Negotiated Rate	$37,543.97
Max. Negotiated Rate	$37,543.97
Rate for Payer: Hawaii Medical Service Association Commercial	$37,543.97

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$38,018.01

Service Code	MSDRG 988
Min. Negotiated Rate	$38,018.01
Max. Negotiated Rate	$38,018.01
Rate for Payer: Hawaii Medical Service Association Commercial	$38,018.01

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$38,018.01

Service Code	MSDRG 987
Min. Negotiated Rate	$38,018.01
Max. Negotiated Rate	$38,018.01
Rate for Payer: Hawaii Medical Service Association Commercial	$38,018.01

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$38,018.01

Service Code	MSDRG 989
Min. Negotiated Rate	$38,018.01
Max. Negotiated Rate	$38,018.01
Rate for Payer: Hawaii Medical Service Association Commercial	$38,018.01

NON-MALIGNANT BREAST DISORDERS WITH CC/MCC

Facility

$15,998.85

Service Code	MSDRG 600
Min. Negotiated Rate	$15,998.85
Max. Negotiated Rate	$15,998.85
Rate for Payer: Hawaii Medical Service Association Commercial	$15,998.85

NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$15,998.85

Service Code	MSDRG 601
Min. Negotiated Rate	$15,998.85
Max. Negotiated Rate	$15,998.85
Rate for Payer: Hawaii Medical Service Association Commercial	$15,998.85

NONTRAUMATIC STUPOR AND COMA WITH MCC

Facility

$32,566.55

Service Code	MSDRG 080
Min. Negotiated Rate	$32,566.55
Max. Negotiated Rate	$32,566.55
Rate for Payer: Hawaii Medical Service Association Commercial	$32,566.55

NONTRAUMATIC STUPOR AND COMA WITHOUT MCC

Facility

$32,566.55

Service Code	MSDRG 081
Min. Negotiated Rate	$32,566.55
Max. Negotiated Rate	$32,566.55
Rate for Payer: Hawaii Medical Service Association Commercial	$32,566.55

NOREPINEPHRINE BITARTRATE 16 MG/250 ML (64 MCG/ML) IN 0.9 % NACL IV [136921]

Facility

$346.00

Service Code	NDC 44567064210
Hospital Revenue Code	250
Min. Negotiated Rate	$294.10
Max. Negotiated Rate	$335.62
Rate for Payer: Cash Price	$207.60
Rate for Payer: Health Management Network Commercial	$294.10
Rate for Payer: Kaiser Permanente Commercial	$311.40
Rate for Payer: MDX Hawaii PPO	$335.62

NOREPINEPHRINE BITARTRATE 16 MG/250 ML (64 MCG/ML) IN 0.9 % NACL IV [136921]

Facility

$346.00

Service Code	NDC 44567064201
Hospital Revenue Code	250
Min. Negotiated Rate	$294.10
Max. Negotiated Rate	$335.62
Rate for Payer: Cash Price	$207.60
Rate for Payer: Health Management Network Commercial	$294.10
Rate for Payer: Kaiser Permanente Commercial	$311.40
Rate for Payer: MDX Hawaii PPO	$335.62

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [128328]

Facility

$77.00

Service Code	NDC 67457085204
Hospital Revenue Code	250
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: MDX Hawaii PPO	$74.69

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [128328]

Facility

$77.00

Service Code	NDC 67457085200
Hospital Revenue Code	250
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: MDX Hawaii PPO	$74.69

NOREPINEPHRINE BITARTRATE 4 MG/250 ML (16 MCG/ML) IN 0.9 % NACL IV [134605]

Facility

$162.00

Service Code	NDC 44567064010
Hospital Revenue Code	250
Min. Negotiated Rate	$137.70
Max. Negotiated Rate	$157.14
Rate for Payer: Cash Price	$97.20
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: Kaiser Permanente Commercial	$145.80
Rate for Payer: MDX Hawaii PPO	$157.14

NOREPINEPHRINE BITARTRATE 4 MG/250 ML (16 MCG/ML) IN 0.9 % NACL IV [134605]

Facility

$162.00

Service Code	NDC 44567064001
Hospital Revenue Code	250
Min. Negotiated Rate	$137.70
Max. Negotiated Rate	$157.14
Rate for Payer: Cash Price	$97.20
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: Kaiser Permanente Commercial	$145.80
Rate for Payer: MDX Hawaii PPO	$157.14

NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) IN 0.9 % NACL IV [134543]

Facility

$215.00

Service Code	NDC 44567064110
Hospital Revenue Code	250
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$129.00
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: MDX Hawaii PPO	$208.55

Know your out-of-pocket cost for care.

All Charges