Kona Community Hospital

All Charges

Charge

Type

Setting

Price

NIM Probe Prass Monopolar Stimulator 8225101E [3610417]

Facility

$785.67

Hospital Charge Code	3610417
Hospital Revenue Code	272
Min. Negotiated Rate	$667.82
Max. Negotiated Rate	$762.10
Rate for Payer: Cash Price	$510.69
Rate for Payer: Health Management Network Commercial	$667.82
Rate for Payer: MDX Hawaii PPO	$762.10

NIRSEVIMAB-ALIP 100 MG/ML IM SYR

Facility

$1,394.54

Service Code	HCPCS 90381
Hospital Revenue Code	250
Min. Negotiated Rate	$600.62
Max. Negotiated Rate	$1,352.70
Rate for Payer: Cash Price	$906.45
Rate for Payer: Cash Price	$906.44
Rate for Payer: Cash Price	$906.44
Rate for Payer: Cash Price	$906.45
Rate for Payer: Hawaii Medical Service Association ABD	$600.62
Rate for Payer: Hawaii Medical Service Association ABD	$600.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$600.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$600.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,324.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,324.81
Rate for Payer: Health Management Network Commercial	$1,185.36
Rate for Payer: Health Management Network Commercial	$1,185.35
Rate for Payer: Kaiser Permanente Commercial	$878.56
Rate for Payer: Kaiser Permanente Commercial	$878.55
Rate for Payer: Kaiser Permanente Medicaid	$711.21
Rate for Payer: Kaiser Permanente Medicaid	$711.22
Rate for Payer: MDX Hawaii PPO	$1,352.70
Rate for Payer: MDX Hawaii PPO	$1,352.69
Rate for Payer: UnitedHealthcare Medicaid	$836.72
Rate for Payer: UnitedHealthcare Medicaid	$836.72
Rate for Payer: University Health Alliance Commercial	$1,016.47
Rate for Payer: University Health Alliance Commercial	$1,016.48

NIRSEVIMAB-ALIP 100 MG/ML IM SYR

Facility

$1,394.53

Service Code	HCPCS 90381
Hospital Revenue Code	250
Min. Negotiated Rate	$1,185.35
Max. Negotiated Rate	$1,352.69
Rate for Payer: Cash Price	$906.44
Rate for Payer: Cash Price	$906.45
Rate for Payer: Health Management Network Commercial	$1,185.35
Rate for Payer: Health Management Network Commercial	$1,185.36
Rate for Payer: MDX Hawaii PPO	$1,352.69
Rate for Payer: MDX Hawaii PPO	$1,352.70

NIRSEVIMAB-ALIP 50 MG/0.5 ML IM SYR

Facility

$1,394.53

Service Code	HCPCS 90380
Hospital Revenue Code	250
Min. Negotiated Rate	$600.62
Max. Negotiated Rate	$1,352.69
Rate for Payer: Cash Price	$906.44
Rate for Payer: Cash Price	$906.45
Rate for Payer: Cash Price	$906.45
Rate for Payer: Cash Price	$906.44
Rate for Payer: Hawaii Medical Service Association ABD	$600.62
Rate for Payer: Hawaii Medical Service Association ABD	$600.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$600.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$600.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,324.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,324.81
Rate for Payer: Health Management Network Commercial	$1,185.36
Rate for Payer: Health Management Network Commercial	$1,185.35
Rate for Payer: Kaiser Permanente Commercial	$878.55
Rate for Payer: Kaiser Permanente Commercial	$878.56
Rate for Payer: Kaiser Permanente Medicaid	$711.22
Rate for Payer: Kaiser Permanente Medicaid	$711.21
Rate for Payer: MDX Hawaii PPO	$1,352.70
Rate for Payer: MDX Hawaii PPO	$1,352.69
Rate for Payer: UnitedHealthcare Medicaid	$836.72
Rate for Payer: UnitedHealthcare Medicaid	$836.72
Rate for Payer: University Health Alliance Commercial	$1,016.48
Rate for Payer: University Health Alliance Commercial	$1,016.47

NIRSEVIMAB-ALIP 50 MG/0.5 ML IM SYR

Facility

$1,394.53

Service Code	HCPCS 90380
Hospital Revenue Code	250
Min. Negotiated Rate	$1,185.35
Max. Negotiated Rate	$1,352.69
Rate for Payer: Cash Price	$906.44
Rate for Payer: Cash Price	$906.45
Rate for Payer: Health Management Network Commercial	$1,185.35
Rate for Payer: Health Management Network Commercial	$1,185.36
Rate for Payer: MDX Hawaii PPO	$1,352.69
Rate for Payer: MDX Hawaii PPO	$1,352.70

NITROFURANTOIN MONOHYD/M-CRYST 100 MG PO CAP

Facility

$22.55

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$19.17
Max. Negotiated Rate	$21.87
Rate for Payer: Cash Price	$14.66
Rate for Payer: Health Management Network Commercial	$19.17
Rate for Payer: MDX Hawaii PPO	$21.87

NITROFURANTOIN MONOHYD/M-CRYST 100 MG PO CAP

Facility

$22.55

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$21.87
Rate for Payer: Cash Price	$14.66
Rate for Payer: Hawaii Western Management Group Commercial	$21.42
Rate for Payer: Health Management Network Commercial	$19.17
Rate for Payer: Kaiser Permanente Commercial	$14.21
Rate for Payer: Kaiser Permanente Medicaid	$11.50
Rate for Payer: MDX Hawaii PPO	$21.87
Rate for Payer: UnitedHealthcare Medicaid	$13.53
Rate for Payer: University Health Alliance Commercial	$16.44

NITROGLYCERIN 0.1 MG TRANSDERM PT24

Facility

$10.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$9.96
Rate for Payer: Cash Price	$6.68
Rate for Payer: Hawaii Western Management Group Commercial	$9.76
Rate for Payer: Health Management Network Commercial	$8.73
Rate for Payer: Kaiser Permanente Commercial	$6.47
Rate for Payer: Kaiser Permanente Medicaid	$5.24
Rate for Payer: MDX Hawaii PPO	$9.96
Rate for Payer: UnitedHealthcare Medicaid	$6.16
Rate for Payer: University Health Alliance Commercial	$7.49

NITROGLYCERIN 0.1 MG TRANSDERM PT24

Facility

$10.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.73
Max. Negotiated Rate	$9.96
Rate for Payer: Cash Price	$6.68
Rate for Payer: Health Management Network Commercial	$8.73
Rate for Payer: MDX Hawaii PPO	$9.96

NITROGLYCERIN 0.2 MG TRANSDERM PT24

Facility

$10.50

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$10.19
Rate for Payer: Cash Price	$6.82
Rate for Payer: Health Management Network Commercial	$8.93
Rate for Payer: MDX Hawaii PPO	$10.19

NITROGLYCERIN 0.2 MG TRANSDERM PT24

Facility

$10.50

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$10.19
Rate for Payer: Cash Price	$6.82
Rate for Payer: Hawaii Western Management Group Commercial	$9.97
Rate for Payer: Health Management Network Commercial	$8.93
Rate for Payer: Kaiser Permanente Commercial	$6.62
Rate for Payer: Kaiser Permanente Medicaid	$5.36
Rate for Payer: MDX Hawaii PPO	$10.19
Rate for Payer: UnitedHealthcare Medicaid	$6.30
Rate for Payer: University Health Alliance Commercial	$7.65

NITROGLYCERIN 0.4 MG/DOSE TRANSLING NON-AER.SPRY

Facility

$706.00

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$600.10
Max. Negotiated Rate	$684.82
Rate for Payer: Cash Price	$458.90
Rate for Payer: Health Management Network Commercial	$600.10
Rate for Payer: MDX Hawaii PPO	$684.82

NITROGLYCERIN 0.4 MG/DOSE TRANSLING NON-AER.SPRY

Facility

$706.00

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$360.06
Max. Negotiated Rate	$684.82
Rate for Payer: Cash Price	$458.90
Rate for Payer: Hawaii Western Management Group Commercial	$670.70
Rate for Payer: Health Management Network Commercial	$600.10
Rate for Payer: Kaiser Permanente Commercial	$444.78
Rate for Payer: Kaiser Permanente Medicaid	$360.06
Rate for Payer: MDX Hawaii PPO	$684.82
Rate for Payer: UnitedHealthcare Medicaid	$423.60
Rate for Payer: University Health Alliance Commercial	$514.60

NITROGLYCERIN 0.4 MG SL SUBL.TAB

Facility

$140.21

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$71.51
Max. Negotiated Rate	$136.00
Rate for Payer: Cash Price	$91.14
Rate for Payer: Cash Price	$92.12
Rate for Payer: Hawaii Western Management Group Commercial	$133.20
Rate for Payer: Hawaii Western Management Group Commercial	$134.64
Rate for Payer: Health Management Network Commercial	$120.47
Rate for Payer: Health Management Network Commercial	$119.18
Rate for Payer: Kaiser Permanente Commercial	$88.33
Rate for Payer: Kaiser Permanente Commercial	$89.29
Rate for Payer: Kaiser Permanente Medicaid	$72.28
Rate for Payer: Kaiser Permanente Medicaid	$71.51
Rate for Payer: MDX Hawaii PPO	$137.48
Rate for Payer: MDX Hawaii PPO	$136.00
Rate for Payer: UnitedHealthcare Medicaid	$84.13
Rate for Payer: UnitedHealthcare Medicaid	$85.04
Rate for Payer: University Health Alliance Commercial	$103.31
Rate for Payer: University Health Alliance Commercial	$102.20

NITROGLYCERIN 0.4 MG SL SUBL.TAB

Facility

$140.21

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$119.18
Max. Negotiated Rate	$136.00
Rate for Payer: Cash Price	$91.14
Rate for Payer: Cash Price	$92.12
Rate for Payer: Health Management Network Commercial	$120.47
Rate for Payer: Health Management Network Commercial	$119.18
Rate for Payer: MDX Hawaii PPO	$137.48
Rate for Payer: MDX Hawaii PPO	$136.00

NITROGLYCERIN 0.4 MG TRANSDERM PT24

Facility

$12.00

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.80
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$7.56
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: UnitedHealthcare Medicaid	$7.20
Rate for Payer: University Health Alliance Commercial	$8.75

NITROGLYCERIN 0.4 MG TRANSDERM PT24

Facility

$12.00

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: MDX Hawaii PPO	$11.64

NITROGLYCERIN 2 % TRANSDERM OINT

Facility

$16.72

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.53
Max. Negotiated Rate	$16.22
Rate for Payer: Cash Price	$10.87
Rate for Payer: Hawaii Western Management Group Commercial	$15.88
Rate for Payer: Health Management Network Commercial	$14.21
Rate for Payer: Kaiser Permanente Commercial	$10.53
Rate for Payer: Kaiser Permanente Medicaid	$8.53
Rate for Payer: MDX Hawaii PPO	$16.22
Rate for Payer: UnitedHealthcare Medicaid	$10.03
Rate for Payer: University Health Alliance Commercial	$12.19

NITROGLYCERIN 2 % TRANSDERM OINT

Facility

$16.72

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.21
Max. Negotiated Rate	$16.22
Rate for Payer: Cash Price	$10.87
Rate for Payer: Health Management Network Commercial	$14.21
Rate for Payer: MDX Hawaii PPO	$16.22

NITROGLYCERIN IN 5 % DEXTROSE 50 MG/250 ML (200 MCG/ML) IV SOLN

Facility

$111.15

Service Code	HCPCS J2305
Hospital Revenue Code	636
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$107.82
Rate for Payer: Cash Price	$72.25
Rate for Payer: Cash Price	$72.25
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	$105.59
Rate for Payer: Health Management Network Commercial	$94.48
Rate for Payer: Kaiser Permanente Commercial	$70.02
Rate for Payer: Kaiser Permanente Medicaid	$56.69
Rate for Payer: MDX Hawaii PPO	$107.82
Rate for Payer: UnitedHealthcare Medicaid	$66.69
Rate for Payer: University Health Alliance Commercial	$81.02

NITROGLYCERIN IN 5 % DEXTROSE 50 MG/250 ML (200 MCG/ML) IV SOLN

Facility

$111.15

Service Code	HCPCS J2305
Hospital Revenue Code	250
Min. Negotiated Rate	$94.48
Max. Negotiated Rate	$107.82
Rate for Payer: Cash Price	$72.25
Rate for Payer: Health Management Network Commercial	$94.48
Rate for Payer: MDX Hawaii PPO	$107.82

NIVOLUMAB 100 MG/10 ML IV SOLN

Facility

$5,089.92

Service Code	HCPCS J9299
Hospital Revenue Code	250
Min. Negotiated Rate	$4,326.43
Max. Negotiated Rate	$4,937.22
Rate for Payer: Cash Price	$3,308.45
Rate for Payer: Health Management Network Commercial	$4,326.43
Rate for Payer: MDX Hawaii PPO	$4,937.22

NIVOLUMAB 100 MG/10 ML IV SOLN

Facility

$5,089.92

Service Code	HCPCS J9299
Hospital Revenue Code	636
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$4,937.22
Rate for Payer: AlohaCare Medicaid	$33.62
Rate for Payer: AlohaCare Medicare	$33.62
Rate for Payer: Cash Price	$3,308.45
Rate for Payer: Cash Price	$3,308.45
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	$4,835.42
Rate for Payer: Health Management Network Commercial	$4,326.43
Rate for Payer: Humana Medicare	$33.62
Rate for Payer: Kaiser Permanente Commercial	$3,206.65
Rate for Payer: Kaiser Permanente Medicaid	$2,595.86
Rate for Payer: Kaiser Permanente Medicare	$33.62
Rate for Payer: MDX Hawaii PPO	$4,937.22
Rate for Payer: Ohana Health Plan Medicaid	$36.98
Rate for Payer: Ohana Health Plan Medicare	$33.62
Rate for Payer: UnitedHealthcare Medicaid	$3,053.95
Rate for Payer: UnitedHealthcare Medicare	$33.62
Rate for Payer: University Health Alliance Commercial	$3,710.04

NIVOLUMAB 120 MG/12 ML IV SOLN

Facility

$5,884.24

Service Code	HCPCS J9299
Hospital Revenue Code	250
Min. Negotiated Rate	$5,001.60
Max. Negotiated Rate	$5,707.71
Rate for Payer: Cash Price	$3,824.76
Rate for Payer: Health Management Network Commercial	$5,001.60
Rate for Payer: MDX Hawaii PPO	$5,707.71

NIVOLUMAB 120 MG/12 ML IV SOLN

Facility

$5,884.24

Service Code	HCPCS J9299
Hospital Revenue Code	636
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$5,707.71
Rate for Payer: AlohaCare Medicaid	$33.62
Rate for Payer: AlohaCare Medicare	$33.62
Rate for Payer: Cash Price	$3,824.76
Rate for Payer: Cash Price	$3,824.76
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	$5,590.03
Rate for Payer: Health Management Network Commercial	$5,001.60
Rate for Payer: Humana Medicare	$33.62
Rate for Payer: Kaiser Permanente Commercial	$3,707.07
Rate for Payer: Kaiser Permanente Medicaid	$3,000.96
Rate for Payer: Kaiser Permanente Medicare	$33.62
Rate for Payer: MDX Hawaii PPO	$5,707.71
Rate for Payer: Ohana Health Plan Medicaid	$36.98
Rate for Payer: Ohana Health Plan Medicare	$33.62
Rate for Payer: UnitedHealthcare Medicaid	$3,530.54
Rate for Payer: UnitedHealthcare Medicare	$33.62
Rate for Payer: University Health Alliance Commercial	$4,289.02

Know your out-of-pocket cost for care.

All Charges