Kona Community Hospital

All Charges

Charge

Type

Setting

Price

INFUSION NORMAL SALINE SOLUTION 250 CC

Professional

Both

$6.00

Service Code	HCPCS J7050
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$5.10
Rate for Payer: AlohaCare Medicare	$0.70
Rate for Payer: Cash Price	$3.90
Rate for Payer: Cash Price	$3.90
Rate for Payer: Devoted Health Medicare	$0.77
Rate for Payer: Hawaii Medical Service Association Medicare	$0.70
Rate for Payer: Hawaii Western Management Group Commercial	$1.49
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$0.84
Rate for Payer: Kaiser Permanente Medicaid	$0.84
Rate for Payer: Kaiser Permanente Medicare	$0.84
Rate for Payer: Ohana Health Plan Medicare	$0.70
Rate for Payer: UnitedHealthcare Medicare	$0.70

INFUSION NORMAL SALINE SOLUTION STERILE

Professional

Both

$9.00

Service Code	HCPCS J7040
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$7.65
Rate for Payer: AlohaCare Medicare	$1.36
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cash Price	$5.85
Rate for Payer: Devoted Health Medicare	$1.50
Rate for Payer: Hawaii Medical Service Association Medicare	$1.36
Rate for Payer: Hawaii Western Management Group Commercial	$1.62
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$1.63
Rate for Payer: Kaiser Permanente Medicaid	$1.63
Rate for Payer: Kaiser Permanente Medicare	$1.63
Rate for Payer: Ohana Health Plan Medicare	$1.36
Rate for Payer: UnitedHealthcare Medicare	$1.36

INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC

Facility

$30,398.93

Service Code	MSDRG 351
Min. Negotiated Rate	$20,051.40
Max. Negotiated Rate	$30,398.93
Rate for Payer: AlohaCare Medicare	$20,051.40
Rate for Payer: Devoted Health Medicare	$22,056.54
Rate for Payer: Hawaii Medical Service Association Commercial	$30,398.93
Rate for Payer: Hawaii Medical Service Association Medicare	$20,051.40
Rate for Payer: Humana Medicare	$20,051.40
Rate for Payer: Kaiser Permanente Commercial	$26,297.62
Rate for Payer: Kaiser Permanente Medicare	$20,051.40
Rate for Payer: Ohana Health Plan Medicare	$20,051.40
Rate for Payer: UnitedHealthcare Medicare	$20,051.40

INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC

Facility

$42,985.28

Service Code	MSDRG 350
Min. Negotiated Rate	$32,775.38
Max. Negotiated Rate	$42,985.28
Rate for Payer: AlohaCare Medicare	$32,775.38
Rate for Payer: Devoted Health Medicare	$36,052.92
Rate for Payer: Hawaii Medical Service Association Commercial	$37,751.56
Rate for Payer: Hawaii Medical Service Association Medicare	$32,775.38
Rate for Payer: Humana Medicare	$32,775.38
Rate for Payer: Kaiser Permanente Commercial	$42,985.28
Rate for Payer: Kaiser Permanente Medicare	$32,775.38
Rate for Payer: Ohana Health Plan Medicare	$32,775.38
Rate for Payer: UnitedHealthcare Medicare	$32,775.38

INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC

Facility

$20,144.55

Service Code	MSDRG 352
Min. Negotiated Rate	$15,359.80
Max. Negotiated Rate	$20,144.55
Rate for Payer: AlohaCare Medicare	$15,359.80
Rate for Payer: Devoted Health Medicare	$16,895.78
Rate for Payer: Hawaii Medical Service Association Commercial	$15,717.76
Rate for Payer: Hawaii Medical Service Association Medicare	$15,359.80
Rate for Payer: Humana Medicare	$15,359.80
Rate for Payer: Kaiser Permanente Commercial	$20,144.55
Rate for Payer: Kaiser Permanente Medicare	$15,359.80
Rate for Payer: Ohana Health Plan Medicare	$15,359.80
Rate for Payer: UnitedHealthcare Medicare	$15,359.80

INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES

Facility

$4,316.89

Service Code	APR-DRG 2281
Min. Negotiated Rate	$4,316.89
Max. Negotiated Rate	$4,316.89
Rate for Payer: AlohaCare Medicaid	$4,316.89
Rate for Payer: Hawaii Medical Service Association ABD	$4,316.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,316.89
Rate for Payer: Kaiser Permanente Medicaid	$4,316.89
Rate for Payer: Ohana Health Plan Medicaid	$4,316.89
Rate for Payer: UnitedHealthcare Medicaid	$4,316.89

INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES

Facility

$8,064.47

Service Code	APR-DRG 2283
Min. Negotiated Rate	$8,064.47
Max. Negotiated Rate	$8,064.47
Rate for Payer: AlohaCare Medicaid	$8,064.47
Rate for Payer: Hawaii Medical Service Association ABD	$8,064.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,064.47
Rate for Payer: Kaiser Permanente Medicaid	$8,064.47
Rate for Payer: Ohana Health Plan Medicaid	$8,064.47
Rate for Payer: UnitedHealthcare Medicaid	$8,064.47

INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES

Facility

$15,211.31

Service Code	APR-DRG 2284
Min. Negotiated Rate	$15,211.31
Max. Negotiated Rate	$15,211.31
Rate for Payer: AlohaCare Medicaid	$15,211.31
Rate for Payer: Hawaii Medical Service Association ABD	$15,211.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,211.31
Rate for Payer: Kaiser Permanente Medicaid	$15,211.31
Rate for Payer: Ohana Health Plan Medicaid	$15,211.31
Rate for Payer: UnitedHealthcare Medicaid	$15,211.31

INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES

Facility

$5,773.89

Service Code	APR-DRG 2282
Min. Negotiated Rate	$5,773.89
Max. Negotiated Rate	$5,773.89
Rate for Payer: AlohaCare Medicaid	$5,773.89
Rate for Payer: Hawaii Medical Service Association ABD	$5,773.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,773.89
Rate for Payer: Kaiser Permanente Medicaid	$5,773.89
Rate for Payer: Ohana Health Plan Medicaid	$5,773.89
Rate for Payer: UnitedHealthcare Medicaid	$5,773.89

INITIAL INPATIENT CONSULT NEW/ESTAB PT 20 MIN

Professional

Both

$150.00

Service Code	HCPCS 99251
Min. Negotiated Rate	$49.51
Max. Negotiated Rate	$127.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Hawaii Western Management Group Commercial	$49.51
Rate for Payer: Health Management Network Commercial	$127.50

INJ ADO-TRASTUZUMAB EMTANSINE 1 MG

Professional

Both

$105.00

Service Code	HCPCS J9354
Min. Negotiated Rate	$29.96
Max. Negotiated Rate	$89.25
Rate for Payer: AlohaCare Medicare	$42.20
Rate for Payer: Cash Price	$68.25
Rate for Payer: Cash Price	$68.25
Rate for Payer: Devoted Health Medicare	$46.42
Rate for Payer: Hawaii Medical Service Association Medicare	$42.20
Rate for Payer: Hawaii Western Management Group Commercial	$29.96
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Kaiser Permanente Commercial	$50.64
Rate for Payer: Kaiser Permanente Medicaid	$50.64
Rate for Payer: Kaiser Permanente Medicare	$50.64
Rate for Payer: Ohana Health Plan Medicare	$42.20
Rate for Payer: UnitedHealthcare Medicare	$42.20

INJ BORTEZOMB HOSPIRA NOT TX EQV TO J9041 0.1 MG

Professional

Both

$22.00

Service Code	HCPCS J9049
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$18.70
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$14.30
Rate for Payer: Cash Price	$14.30
Rate for Payer: Devoted Health Medicare	$1.39
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Kaiser Permanente Commercial	$1.51
Rate for Payer: Kaiser Permanente Medicaid	$1.51
Rate for Payer: Kaiser Permanente Medicare	$1.51
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicare	$1.26

INJECTION AGALSIDASE BETA 1 MG

Professional

Both

$568.00

Service Code	HCPCS J0180
Min. Negotiated Rate	$227.58
Max. Negotiated Rate	$482.80
Rate for Payer: AlohaCare Medicare	$227.58
Rate for Payer: Cash Price	$369.20
Rate for Payer: Cash Price	$369.20
Rate for Payer: Devoted Health Medicare	$250.34
Rate for Payer: Hawaii Medical Service Association Medicare	$227.58
Rate for Payer: Health Management Network Commercial	$482.80
Rate for Payer: Kaiser Permanente Commercial	$273.10
Rate for Payer: Kaiser Permanente Medicaid	$273.10
Rate for Payer: Kaiser Permanente Medicare	$273.10
Rate for Payer: Ohana Health Plan Medicare	$227.58
Rate for Payer: UnitedHealthcare Medicare	$227.58

INJECTION ALTEPLASE RECOMBINANT 1 MG

Professional

Both

$263.00

Service Code	HCPCS J2997
Min. Negotiated Rate	$49.64
Max. Negotiated Rate	$223.55
Rate for Payer: AlohaCare Medicare	$95.09
Rate for Payer: Cash Price	$170.95
Rate for Payer: Cash Price	$170.95
Rate for Payer: Devoted Health Medicare	$104.60
Rate for Payer: Hawaii Medical Service Association Medicare	$95.09
Rate for Payer: Hawaii Western Management Group Commercial	$49.64
Rate for Payer: Health Management Network Commercial	$223.55
Rate for Payer: Kaiser Permanente Commercial	$114.11
Rate for Payer: Kaiser Permanente Medicaid	$114.11
Rate for Payer: Kaiser Permanente Medicare	$114.11
Rate for Payer: Ohana Health Plan Medicare	$95.09
Rate for Payer: UnitedHealthcare Medicare	$95.09

INJECTION APREPITANT 1 MG

Professional

Both

$5.00

Service Code	HCPCS J0185
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$4.25
Rate for Payer: AlohaCare Medicare	$1.69
Rate for Payer: Cash Price	$3.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Devoted Health Medicare	$1.86
Rate for Payer: Hawaii Medical Service Association Medicare	$1.69
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$2.03
Rate for Payer: Kaiser Permanente Medicaid	$2.03
Rate for Payer: Kaiser Permanente Medicare	$2.03
Rate for Payer: Ohana Health Plan Medicare	$1.69
Rate for Payer: UnitedHealthcare Medicare	$1.69

INJECTION ARSENIC TRIOXIDE 1 MG

Professional

Both

$46.00

Service Code	HCPCS J9017
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$80.19
Rate for Payer: Ohana Health Plan Medicare	$6.45
Rate for Payer: AlohaCare Medicare	$6.45
Rate for Payer: Cash Price	$29.90
Rate for Payer: Cash Price	$29.90
Rate for Payer: Devoted Health Medicare	$7.09
Rate for Payer: Hawaii Medical Service Association Medicare	$6.45
Rate for Payer: Hawaii Western Management Group Commercial	$80.19
Rate for Payer: Health Management Network Commercial	$39.10
Rate for Payer: Kaiser Permanente Commercial	$7.74
Rate for Payer: Kaiser Permanente Medicaid	$7.74
Rate for Payer: Kaiser Permanente Medicare	$7.74
Rate for Payer: UnitedHealthcare Medicare	$6.45

INJECTION ATEZOLIZUMAB 10 MG

Professional

Both

$240.00

Service Code	HCPCS J9022
Min. Negotiated Rate	$94.00
Max. Negotiated Rate	$204.00
Rate for Payer: AlohaCare Medicare	$94.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Devoted Health Medicare	$103.40
Rate for Payer: Hawaii Medical Service Association Medicare	$94.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Kaiser Permanente Commercial	$112.80
Rate for Payer: Kaiser Permanente Medicaid	$112.80
Rate for Payer: Kaiser Permanente Medicare	$112.80
Rate for Payer: Ohana Health Plan Medicare	$94.00
Rate for Payer: UnitedHealthcare Medicare	$94.00

INJECTION ATROPINE SULFATE 0.01 MG

Professional

Both

$1.00

Service Code	HCPCS J0461
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.85
Rate for Payer: AlohaCare Medicare	$0.10
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cash Price	$0.65
Rate for Payer: Devoted Health Medicare	$0.11
Rate for Payer: Hawaii Medical Service Association Medicare	$0.10
Rate for Payer: Hawaii Western Management Group Commercial	$0.05
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.12
Rate for Payer: Kaiser Permanente Medicaid	$0.12
Rate for Payer: Kaiser Permanente Medicare	$0.12
Rate for Payer: Ohana Health Plan Medicare	$0.10
Rate for Payer: UnitedHealthcare Medicare	$0.10

INJECTION AVELUMAB 10 MG

Professional

Both

$260.00

Service Code	HCPCS J9023
Min. Negotiated Rate	$105.55
Max. Negotiated Rate	$221.00
Rate for Payer: AlohaCare Medicare	$105.55
Rate for Payer: Cash Price	$169.00
Rate for Payer: Cash Price	$169.00
Rate for Payer: Devoted Health Medicare	$116.11
Rate for Payer: Hawaii Medical Service Association Medicare	$105.55
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: Kaiser Permanente Commercial	$126.66
Rate for Payer: Kaiser Permanente Medicaid	$126.66
Rate for Payer: Kaiser Permanente Medicare	$126.66
Rate for Payer: Ohana Health Plan Medicare	$105.55
Rate for Payer: UnitedHealthcare Medicare	$105.55

INJECTION AZACITIDINE 1 MG

Professional

Both

$3.00

Service Code	HCPCS J9025
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$2.55
Rate for Payer: AlohaCare Medicare	$0.41
Rate for Payer: Cash Price	$1.95
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$0.45
Rate for Payer: Hawaii Medical Service Association Medicare	$0.41
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$0.49
Rate for Payer: Kaiser Permanente Medicaid	$0.49
Rate for Payer: Kaiser Permanente Medicare	$0.49
Rate for Payer: Ohana Health Plan Medicare	$0.41
Rate for Payer: UnitedHealthcare Medicare	$0.41

INJECTION BELINOSTAT 10 MG

Professional

Both

$130.00

Service Code	HCPCS J9032
Min. Negotiated Rate	$53.11
Max. Negotiated Rate	$110.50
Rate for Payer: AlohaCare Medicare	$53.11
Rate for Payer: Cash Price	$84.50
Rate for Payer: Cash Price	$84.50
Rate for Payer: Devoted Health Medicare	$58.42
Rate for Payer: Hawaii Medical Service Association Medicare	$53.11
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Kaiser Permanente Commercial	$63.73
Rate for Payer: Kaiser Permanente Medicaid	$63.73
Rate for Payer: Kaiser Permanente Medicare	$63.73
Rate for Payer: Ohana Health Plan Medicare	$53.11
Rate for Payer: UnitedHealthcare Medicare	$53.11

INJECTION BENDAMUSTINE HCL BENDEKA 1 MG

Professional

Both

$52.00

Service Code	HCPCS J9034
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$44.20
Rate for Payer: AlohaCare Medicare	$12.90
Rate for Payer: Cash Price	$33.80
Rate for Payer: Cash Price	$33.80
Rate for Payer: Devoted Health Medicare	$14.19
Rate for Payer: Hawaii Medical Service Association Medicare	$12.90
Rate for Payer: Hawaii Western Management Group Commercial	$26.72
Rate for Payer: Health Management Network Commercial	$44.20
Rate for Payer: Kaiser Permanente Commercial	$15.48
Rate for Payer: Kaiser Permanente Medicaid	$15.48
Rate for Payer: Kaiser Permanente Medicare	$15.48
Rate for Payer: Ohana Health Plan Medicare	$12.90
Rate for Payer: UnitedHealthcare Medicare	$12.90

INJECTION BENDAMUSTINE HCL TREANDA 1 MG

Professional

Both

$50.00

Service Code	HCPCS J9033
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$42.50
Rate for Payer: AlohaCare Medicare	$2.16
Rate for Payer: Cash Price	$32.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Devoted Health Medicare	$2.38
Rate for Payer: Hawaii Medical Service Association Medicare	$2.16
Rate for Payer: Health Management Network Commercial	$42.50
Rate for Payer: Kaiser Permanente Commercial	$2.59
Rate for Payer: Kaiser Permanente Medicaid	$2.59
Rate for Payer: Kaiser Permanente Medicare	$2.59
Rate for Payer: Ohana Health Plan Medicare	$2.16
Rate for Payer: UnitedHealthcare Medicare	$2.16

INJECTION BENDAMUSTINE HYDROCHLORIDE 1 MG

Professional

Both

$60.00

Service Code	HCPCS J9036
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$51.00
Rate for Payer: AlohaCare Medicare	$13.94
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Devoted Health Medicare	$15.33
Rate for Payer: Hawaii Medical Service Association Medicare	$13.94
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Kaiser Permanente Commercial	$16.73
Rate for Payer: Kaiser Permanente Medicaid	$16.73
Rate for Payer: Kaiser Permanente Medicare	$16.73
Rate for Payer: Ohana Health Plan Medicare	$13.94
Rate for Payer: UnitedHealthcare Medicare	$13.94

INJECTION BEVACIZUMAB 10 MG

Professional

Both

$205.00

Service Code	HCPCS J9035
Min. Negotiated Rate	$74.36
Max. Negotiated Rate	$174.25
Rate for Payer: AlohaCare Medicare	$74.36
Rate for Payer: Cash Price	$133.25
Rate for Payer: Cash Price	$133.25
Rate for Payer: Devoted Health Medicare	$81.80
Rate for Payer: Hawaii Medical Service Association Medicare	$74.36
Rate for Payer: Health Management Network Commercial	$174.25
Rate for Payer: Kaiser Permanente Commercial	$89.23
Rate for Payer: Kaiser Permanente Medicaid	$89.23
Rate for Payer: Kaiser Permanente Medicare	$89.23
Rate for Payer: Ohana Health Plan Medicare	$74.36
Rate for Payer: UnitedHealthcare Medicare	$74.36

Know your out-of-pocket cost for care.

All Charges