Kona Community Hospital

All Charges

Charge

Type

Setting

Price

INJECTION BEVACIZUMAB-AWWB BIOSIMILAR 10 MG

Professional

Both

$100.00

Service Code	HCPCS Q5107
Min. Negotiated Rate	$23.74
Max. Negotiated Rate	$85.00
Rate for Payer: AlohaCare Medicare	$23.74
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Devoted Health Medicare	$26.11
Rate for Payer: Hawaii Medical Service Association Medicare	$23.74
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Kaiser Permanente Commercial	$28.49
Rate for Payer: Kaiser Permanente Medicaid	$28.49
Rate for Payer: Kaiser Permanente Medicare	$28.49
Rate for Payer: Ohana Health Plan Medicare	$23.74
Rate for Payer: UnitedHealthcare Medicare	$23.74

INJECTION BLEOMYCIN SULFATE 15 UNITS

Professional

Both

$306.00

Service Code	HCPCS J9040
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$260.10
Rate for Payer: AlohaCare Medicare	$16.60
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Devoted Health Medicare	$18.26
Rate for Payer: Hawaii Medical Service Association Medicare	$16.60
Rate for Payer: Hawaii Western Management Group Commercial	$11.00
Rate for Payer: Health Management Network Commercial	$260.10
Rate for Payer: Kaiser Permanente Commercial	$19.92
Rate for Payer: Kaiser Permanente Medicaid	$19.92
Rate for Payer: Kaiser Permanente Medicare	$19.92
Rate for Payer: Ohana Health Plan Medicare	$16.60
Rate for Payer: UnitedHealthcare Medicare	$16.60

INJECTION BLINATUMOMAB 1 MICROGRAM

Professional

Both

$375.00

Service Code	HCPCS J9039
Min. Negotiated Rate	$163.96
Max. Negotiated Rate	$318.75
Rate for Payer: AlohaCare Medicare	$163.96
Rate for Payer: Cash Price	$243.75
Rate for Payer: Cash Price	$243.75
Rate for Payer: Devoted Health Medicare	$180.36
Rate for Payer: Hawaii Medical Service Association Medicare	$163.96
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: Kaiser Permanente Commercial	$196.75
Rate for Payer: Kaiser Permanente Medicaid	$196.75
Rate for Payer: Kaiser Permanente Medicare	$196.75
Rate for Payer: Ohana Health Plan Medicare	$163.96
Rate for Payer: UnitedHealthcare Medicare	$163.96

INJECTION BORTEZOMIB 0.1 MG

Professional

Both

$75.00

Service Code	HCPCS J9041
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$63.75
Rate for Payer: AlohaCare Medicare	$2.25
Rate for Payer: Cash Price	$48.75
Rate for Payer: Cash Price	$48.75
Rate for Payer: Devoted Health Medicare	$2.48
Rate for Payer: Hawaii Medical Service Association Medicare	$2.25
Rate for Payer: Hawaii Western Management Group Commercial	$49.74
Rate for Payer: Health Management Network Commercial	$63.75
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$2.70
Rate for Payer: Kaiser Permanente Medicare	$2.70
Rate for Payer: Ohana Health Plan Medicare	$2.25
Rate for Payer: UnitedHealthcare Medicare	$2.25

INJECTION BRENTUXIMAB VEDOTIN 1 MG

Professional

Both

$590.00

Service Code	HCPCS J9042
Min. Negotiated Rate	$268.73
Max. Negotiated Rate	$501.50
Rate for Payer: AlohaCare Medicare	$268.73
Rate for Payer: Cash Price	$383.50
Rate for Payer: Cash Price	$383.50
Rate for Payer: Devoted Health Medicare	$295.60
Rate for Payer: Hawaii Medical Service Association Medicare	$268.73
Rate for Payer: Health Management Network Commercial	$501.50
Rate for Payer: Kaiser Permanente Commercial	$322.48
Rate for Payer: Kaiser Permanente Medicaid	$322.48
Rate for Payer: Kaiser Permanente Medicare	$322.48
Rate for Payer: Ohana Health Plan Medicare	$268.73
Rate for Payer: UnitedHealthcare Medicare	$268.73

INJECTION CABAZITAXEL 1 MG

Professional

Both

$575.00

Service Code	HCPCS J9043
Min. Negotiated Rate	$231.05
Max. Negotiated Rate	$488.75
Rate for Payer: AlohaCare Medicare	$231.05
Rate for Payer: Cash Price	$373.75
Rate for Payer: Cash Price	$373.75
Rate for Payer: Devoted Health Medicare	$254.16
Rate for Payer: Hawaii Medical Service Association Medicare	$231.05
Rate for Payer: Health Management Network Commercial	$488.75
Rate for Payer: Kaiser Permanente Commercial	$277.26
Rate for Payer: Kaiser Permanente Medicaid	$277.26
Rate for Payer: Kaiser Permanente Medicare	$277.26
Rate for Payer: Ohana Health Plan Medicare	$231.05
Rate for Payer: UnitedHealthcare Medicare	$231.05

INJECTION CALCIUM GLUCONATE/FRESEN KABI PER10 ML

Professional

Both

$11.00

Service Code	HCPCS J0610
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$9.35
Rate for Payer: Cash Price	$7.15
Rate for Payer: Cash Price	$7.15
Rate for Payer: Hawaii Western Management Group Commercial	$2.93
Rate for Payer: Health Management Network Commercial	$9.35

INJECTION CARBOPLATIN 50 MG

Professional

Both

$121.00

Service Code	HCPCS J9045
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$102.85
Rate for Payer: AlohaCare Medicare	$2.94
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cash Price	$78.65
Rate for Payer: Devoted Health Medicare	$3.23
Rate for Payer: Hawaii Medical Service Association Medicare	$2.94
Rate for Payer: Hawaii Western Management Group Commercial	$7.80
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Kaiser Permanente Commercial	$3.53
Rate for Payer: Kaiser Permanente Medicaid	$3.53
Rate for Payer: Kaiser Permanente Medicare	$3.53
Rate for Payer: Ohana Health Plan Medicare	$2.94
Rate for Payer: UnitedHealthcare Medicare	$2.94

INJECTION CARFILZOMIB 1 MG

Professional

Both

$125.00

Service Code	HCPCS J9047
Min. Negotiated Rate	$43.84
Max. Negotiated Rate	$106.25
Rate for Payer: AlohaCare Medicare	$56.24
Rate for Payer: Cash Price	$81.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Devoted Health Medicare	$61.86
Rate for Payer: Hawaii Medical Service Association Medicare	$56.24
Rate for Payer: Hawaii Western Management Group Commercial	$43.84
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$67.49
Rate for Payer: Kaiser Permanente Medicaid	$67.49
Rate for Payer: Kaiser Permanente Medicare	$67.49
Rate for Payer: Ohana Health Plan Medicare	$56.24
Rate for Payer: UnitedHealthcare Medicare	$56.24

INJECTION CARMUSTINE 100 MG

Professional

Both

$1,500.00

Service Code	HCPCS J9050
Min. Negotiated Rate	$152.33
Max. Negotiated Rate	$1,275.00
Rate for Payer: AlohaCare Medicare	$241.80
Rate for Payer: Cash Price	$975.00
Rate for Payer: Cash Price	$975.00
Rate for Payer: Devoted Health Medicare	$265.98
Rate for Payer: Hawaii Medical Service Association Medicare	$241.80
Rate for Payer: Hawaii Western Management Group Commercial	$152.33
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: Kaiser Permanente Commercial	$290.16
Rate for Payer: Kaiser Permanente Medicaid	$290.16
Rate for Payer: Kaiser Permanente Medicare	$290.16
Rate for Payer: Ohana Health Plan Medicare	$241.80
Rate for Payer: UnitedHealthcare Medicare	$241.80

INJECTION CEMIPLIMAB-RWLC 1 MG

Professional

Both

$83.00

Service Code	HCPCS J9119
Min. Negotiated Rate	$29.76
Max. Negotiated Rate	$70.55
Rate for Payer: AlohaCare Medicare	$29.76
Rate for Payer: Cash Price	$53.95
Rate for Payer: Cash Price	$53.95
Rate for Payer: Devoted Health Medicare	$32.74
Rate for Payer: Hawaii Medical Service Association Medicare	$29.76
Rate for Payer: Health Management Network Commercial	$70.55
Rate for Payer: Kaiser Permanente Commercial	$35.71
Rate for Payer: Kaiser Permanente Medicaid	$35.71
Rate for Payer: Kaiser Permanente Medicare	$35.71
Rate for Payer: Ohana Health Plan Medicare	$29.76
Rate for Payer: UnitedHealthcare Medicare	$29.76

INJECTION CETUXIMAB 10 MG

Professional

Both

$200.00

Service Code	HCPCS J9055
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$170.00
Rate for Payer: AlohaCare Medicare	$80.46
Rate for Payer: Cash Price	$130.00
Rate for Payer: Cash Price	$130.00
Rate for Payer: Devoted Health Medicare	$88.51
Rate for Payer: Hawaii Medical Service Association Medicare	$80.46
Rate for Payer: Hawaii Western Management Group Commercial	$57.60
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$96.55
Rate for Payer: Kaiser Permanente Medicaid	$96.55
Rate for Payer: Kaiser Permanente Medicare	$96.55
Rate for Payer: Ohana Health Plan Medicare	$80.46
Rate for Payer: UnitedHealthcare Medicare	$80.46

INJECTION CISPLATIN POWDER OR SOLUTION 10 MG

Professional

Both

$47.00

Service Code	HCPCS J9060
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$64.53
Rate for Payer: AlohaCare Medicare	$2.17
Rate for Payer: Cash Price	$30.55
Rate for Payer: Cash Price	$30.55
Rate for Payer: Devoted Health Medicare	$2.39
Rate for Payer: Hawaii Medical Service Association Medicare	$2.17
Rate for Payer: Hawaii Western Management Group Commercial	$64.53
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Kaiser Permanente Commercial	$2.60
Rate for Payer: Kaiser Permanente Medicaid	$2.60
Rate for Payer: Kaiser Permanente Medicare	$2.60
Rate for Payer: Ohana Health Plan Medicare	$2.17
Rate for Payer: UnitedHealthcare Medicare	$2.17

INJECTION CLADRIBINE PER 1 MG

Professional

Both

$50.00

Service Code	HCPCS J9065
Min. Negotiated Rate	$8.73
Max. Negotiated Rate	$86.40
Rate for Payer: AlohaCare Medicare	$8.73
Rate for Payer: Cash Price	$32.50
Rate for Payer: Cash Price	$32.50
Rate for Payer: Devoted Health Medicare	$9.60
Rate for Payer: Hawaii Medical Service Association Medicare	$8.73
Rate for Payer: Hawaii Western Management Group Commercial	$86.40
Rate for Payer: Health Management Network Commercial	$42.50
Rate for Payer: Kaiser Permanente Commercial	$10.48
Rate for Payer: Kaiser Permanente Medicaid	$10.48
Rate for Payer: Kaiser Permanente Medicare	$10.48
Rate for Payer: Ohana Health Plan Medicare	$8.73
Rate for Payer: UnitedHealthcare Medicare	$8.73

INJECTION CYTARABINE 100 MG

Professional

Both

$7.00

Service Code	HCPCS J9100
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$11.25
Rate for Payer: AlohaCare Medicare	$0.80
Rate for Payer: Cash Price	$4.55
Rate for Payer: Cash Price	$4.55
Rate for Payer: Devoted Health Medicare	$0.88
Rate for Payer: Hawaii Medical Service Association Medicare	$0.80
Rate for Payer: Hawaii Western Management Group Commercial	$11.25
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$0.96
Rate for Payer: Kaiser Permanente Medicaid	$0.96
Rate for Payer: Kaiser Permanente Medicare	$0.96
Rate for Payer: Ohana Health Plan Medicare	$0.80
Rate for Payer: UnitedHealthcare Medicare	$0.80

INJECTION DACTINOMYCIN 0.5 MG

Professional

Both

$2,525.00

Service Code	HCPCS J9120
Min. Negotiated Rate	$20.41
Max. Negotiated Rate	$2,146.25
Rate for Payer: AlohaCare Medicare	$337.67
Rate for Payer: Cash Price	$1,641.25
Rate for Payer: Cash Price	$1,641.25
Rate for Payer: Devoted Health Medicare	$371.44
Rate for Payer: Hawaii Medical Service Association Medicare	$337.67
Rate for Payer: Hawaii Western Management Group Commercial	$20.41
Rate for Payer: Health Management Network Commercial	$2,146.25
Rate for Payer: Kaiser Permanente Commercial	$405.20
Rate for Payer: Kaiser Permanente Medicaid	$405.20
Rate for Payer: Kaiser Permanente Medicare	$405.20
Rate for Payer: Ohana Health Plan Medicare	$337.67
Rate for Payer: UnitedHealthcare Medicare	$337.67

INJECTION DARATUMUMAB 10 MG

Professional

Both

$170.00

Service Code	HCPCS J9145
Min. Negotiated Rate	$70.77
Max. Negotiated Rate	$144.50
Rate for Payer: AlohaCare Medicare	$70.77
Rate for Payer: Cash Price	$110.50
Rate for Payer: Cash Price	$110.50
Rate for Payer: Devoted Health Medicare	$77.85
Rate for Payer: Hawaii Medical Service Association Medicare	$70.77
Rate for Payer: Health Management Network Commercial	$144.50
Rate for Payer: Kaiser Permanente Commercial	$84.92
Rate for Payer: Kaiser Permanente Medicaid	$84.92
Rate for Payer: Kaiser Permanente Medicare	$84.92
Rate for Payer: Ohana Health Plan Medicare	$70.77
Rate for Payer: UnitedHealthcare Medicare	$70.77

INJECTION DARATUMUMAB 10 MG & HYALURONIDASE-FIHJ

Professional

Both

$132.00

Service Code	HCPCS J9144
Min. Negotiated Rate	$55.03
Max. Negotiated Rate	$112.20
Rate for Payer: AlohaCare Medicare	$55.03
Rate for Payer: Cash Price	$85.80
Rate for Payer: Cash Price	$85.80
Rate for Payer: Devoted Health Medicare	$60.53
Rate for Payer: Hawaii Medical Service Association Medicare	$55.03
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: Kaiser Permanente Commercial	$66.04
Rate for Payer: Kaiser Permanente Medicaid	$66.04
Rate for Payer: Kaiser Permanente Medicare	$66.04
Rate for Payer: Ohana Health Plan Medicare	$55.03
Rate for Payer: UnitedHealthcare Medicare	$55.03

INJECTION DARBEPOETIN ALFA 1 MCG NON-ESRD USE

Professional

Both

$10.00

Service Code	HCPCS J0881
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$8.50
Rate for Payer: AlohaCare Medicare	$3.07
Rate for Payer: Cash Price	$6.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Devoted Health Medicare	$3.38
Rate for Payer: Hawaii Medical Service Association Medicare	$3.07
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$3.68
Rate for Payer: Kaiser Permanente Medicaid	$3.68
Rate for Payer: Kaiser Permanente Medicare	$3.68
Rate for Payer: Ohana Health Plan Medicare	$3.07
Rate for Payer: UnitedHealthcare Medicare	$3.07

INJECTION DAUNORUBICIN 10 MG

Professional

Both

$125.00

Service Code	HCPCS J9150
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$139.54
Rate for Payer: AlohaCare Medicare	$24.75
Rate for Payer: Cash Price	$81.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Devoted Health Medicare	$27.23
Rate for Payer: Hawaii Medical Service Association Medicare	$24.75
Rate for Payer: Hawaii Western Management Group Commercial	$139.54
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$29.70
Rate for Payer: Kaiser Permanente Medicaid	$29.70
Rate for Payer: Kaiser Permanente Medicare	$29.70
Rate for Payer: Ohana Health Plan Medicare	$24.75
Rate for Payer: UnitedHealthcare Medicare	$24.75

INJECTION DECITABINE 1 MG

Professional

Both

$5.00

Service Code	HCPCS J0894
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$4.25
Rate for Payer: AlohaCare Medicare	$1.00
Rate for Payer: Cash Price	$3.25
Rate for Payer: Cash Price	$3.25
Rate for Payer: Devoted Health Medicare	$1.10
Rate for Payer: Hawaii Medical Service Association Medicare	$1.00
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$1.20
Rate for Payer: Kaiser Permanente Medicaid	$1.20
Rate for Payer: Kaiser Permanente Medicare	$1.20
Rate for Payer: Ohana Health Plan Medicare	$1.00
Rate for Payer: UnitedHealthcare Medicare	$1.00

INJECTION DEFEROXAMINE MESYLATE 500 MG

Professional

Both

$24.00

Service Code	HCPCS J0895
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$20.40
Rate for Payer: AlohaCare Medicare	$8.58
Rate for Payer: Cash Price	$15.60
Rate for Payer: Cash Price	$15.60
Rate for Payer: Devoted Health Medicare	$9.44
Rate for Payer: Hawaii Medical Service Association Medicare	$8.58
Rate for Payer: Hawaii Western Management Group Commercial	$17.91
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Kaiser Permanente Commercial	$10.30
Rate for Payer: Kaiser Permanente Medicaid	$10.30
Rate for Payer: Kaiser Permanente Medicare	$10.30
Rate for Payer: Ohana Health Plan Medicare	$8.58
Rate for Payer: UnitedHealthcare Medicare	$8.58

INJECTION DEGARELIX 1 MG

Professional

Both

$12.00

Service Code	HCPCS J9155
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$10.20
Rate for Payer: AlohaCare Medicare	$4.46
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$4.91
Rate for Payer: Hawaii Medical Service Association Medicare	$4.46
Rate for Payer: Hawaii Western Management Group Commercial	$6.86
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$5.35
Rate for Payer: Kaiser Permanente Medicaid	$5.35
Rate for Payer: Kaiser Permanente Medicare	$5.35
Rate for Payer: Ohana Health Plan Medicare	$4.46
Rate for Payer: UnitedHealthcare Medicare	$4.46

INJECTION DENOSUMAB 1 MG

Professional

Both

$64.00

Service Code	HCPCS J0897
Min. Negotiated Rate	$17.13
Max. Negotiated Rate	$54.40
Rate for Payer: AlohaCare Medicare	$29.51
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$41.60
Rate for Payer: Devoted Health Medicare	$32.46
Rate for Payer: Hawaii Medical Service Association Medicare	$29.51
Rate for Payer: Hawaii Western Management Group Commercial	$17.13
Rate for Payer: Health Management Network Commercial	$54.40
Rate for Payer: Kaiser Permanente Commercial	$35.41
Rate for Payer: Kaiser Permanente Medicaid	$35.41
Rate for Payer: Kaiser Permanente Medicare	$35.41
Rate for Payer: Ohana Health Plan Medicare	$29.51
Rate for Payer: UnitedHealthcare Medicare	$29.51

INJECTION DESMOPRESSIN ACETATE PER 1 MCG

Professional

Both

$22.00

Service Code	HCPCS J2597
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$18.70
Rate for Payer: AlohaCare Medicare	$3.41
Rate for Payer: Cash Price	$14.30
Rate for Payer: Cash Price	$14.30
Rate for Payer: Devoted Health Medicare	$3.75
Rate for Payer: Hawaii Medical Service Association Medicare	$3.41
Rate for Payer: Hawaii Western Management Group Commercial	$9.07
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Kaiser Permanente Commercial	$4.09
Rate for Payer: Kaiser Permanente Medicaid	$4.09
Rate for Payer: Kaiser Permanente Medicare	$4.09
Rate for Payer: Ohana Health Plan Medicare	$3.41
Rate for Payer: UnitedHealthcare Medicare	$3.41

Know your out-of-pocket cost for care.

All Charges