Kona Community Hospital

All Charges

Charge

Type

Setting

Price

INJECTION FULVESTRANT 25 MG

Professional

Both

$40.00

Service Code	HCPCS J9395
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$93.40
Rate for Payer: AlohaCare Medicare	$4.94
Rate for Payer: Cash Price	$26.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Devoted Health Medicare	$5.43
Rate for Payer: Hawaii Medical Service Association Medicare	$4.94
Rate for Payer: Hawaii Western Management Group Commercial	$93.40
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Kaiser Permanente Commercial	$5.93
Rate for Payer: Kaiser Permanente Medicaid	$5.93
Rate for Payer: Kaiser Permanente Medicare	$5.93
Rate for Payer: Ohana Health Plan Medicare	$4.94
Rate for Payer: UnitedHealthcare Medicare	$4.94

INJECTION FUROSEMIDE UP TO 20 MG

Professional

Both

$2.00

Service Code	HCPCS J1940
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$2.12
Rate for Payer: Cash Price	$1.30
Rate for Payer: Cash Price	$1.30
Rate for Payer: Hawaii Western Management Group Commercial	$2.12
Rate for Payer: Health Management Network Commercial	$1.70

INJECTION GEMCITABINE HCL NOS 200 MG

Professional

Both

$113.00

Service Code	HCPCS J9201
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$130.72
Rate for Payer: AlohaCare Medicare	$3.24
Rate for Payer: Cash Price	$73.45
Rate for Payer: Cash Price	$73.45
Rate for Payer: Devoted Health Medicare	$3.56
Rate for Payer: Hawaii Medical Service Association Medicare	$3.24
Rate for Payer: Hawaii Western Management Group Commercial	$130.72
Rate for Payer: Health Management Network Commercial	$96.05
Rate for Payer: Kaiser Permanente Commercial	$3.89
Rate for Payer: Kaiser Permanente Medicaid	$3.89
Rate for Payer: Kaiser Permanente Medicare	$3.89
Rate for Payer: Ohana Health Plan Medicare	$3.24
Rate for Payer: UnitedHealthcare Medicare	$3.24

INJECTION GRANISETRON EXTENDED-RELEASE 0.1 MG

Professional

Both

$20.00

Service Code	HCPCS J1627
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$17.00
Rate for Payer: AlohaCare Medicare	$3.88
Rate for Payer: Cash Price	$13.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Devoted Health Medicare	$4.27
Rate for Payer: Hawaii Medical Service Association Medicare	$3.88
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$4.66
Rate for Payer: Kaiser Permanente Medicaid	$4.66
Rate for Payer: Kaiser Permanente Medicare	$4.66
Rate for Payer: Ohana Health Plan Medicare	$3.88
Rate for Payer: UnitedHealthcare Medicare	$3.88

INJECTION GRANISETRON HYDROCHLORIDE 100 MCG

Professional

Both

$20.00

Service Code	HCPCS J1626
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$19.52
Rate for Payer: AlohaCare Medicare	$0.16
Rate for Payer: Cash Price	$13.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Devoted Health Medicare	$0.18
Rate for Payer: Hawaii Medical Service Association Medicare	$0.16
Rate for Payer: Hawaii Western Management Group Commercial	$19.52
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$0.19
Rate for Payer: Kaiser Permanente Medicaid	$0.19
Rate for Payer: Kaiser Permanente Medicare	$0.19
Rate for Payer: Ohana Health Plan Medicare	$0.16
Rate for Payer: UnitedHealthcare Medicare	$0.16

INJECTION IDARUBICIN HCL 5 MG

Professional

Both

$378.00

Service Code	HCPCS J9211
Min. Negotiated Rate	$39.76
Max. Negotiated Rate	$457.47
Rate for Payer: AlohaCare Medicare	$39.76
Rate for Payer: Cash Price	$245.70
Rate for Payer: Cash Price	$245.70
Rate for Payer: Devoted Health Medicare	$43.74
Rate for Payer: Hawaii Medical Service Association Medicare	$39.76
Rate for Payer: Hawaii Western Management Group Commercial	$457.47
Rate for Payer: Health Management Network Commercial	$321.30
Rate for Payer: Kaiser Permanente Commercial	$47.71
Rate for Payer: Kaiser Permanente Medicaid	$47.71
Rate for Payer: Kaiser Permanente Medicare	$47.71
Rate for Payer: Ohana Health Plan Medicare	$39.76
Rate for Payer: UnitedHealthcare Medicare	$39.76

INJECTION IFOSFAMIDE 1 G

Professional

Both

$165.00

Service Code	HCPCS J9208
Min. Negotiated Rate	$24.68
Max. Negotiated Rate	$205.27
Rate for Payer: AlohaCare Medicare	$24.68
Rate for Payer: Cash Price	$107.25
Rate for Payer: Cash Price	$107.25
Rate for Payer: Devoted Health Medicare	$27.15
Rate for Payer: Hawaii Medical Service Association Medicare	$24.68
Rate for Payer: Hawaii Western Management Group Commercial	$205.27
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: Kaiser Permanente Commercial	$29.62
Rate for Payer: Kaiser Permanente Medicaid	$29.62
Rate for Payer: Kaiser Permanente Medicare	$29.62
Rate for Payer: Ohana Health Plan Medicare	$24.68
Rate for Payer: UnitedHealthcare Medicare	$24.68

INJECTION IMMUNE GLOBULIN NONLYOPHILIZED 500 MG

Professional

Both

$140.00

Service Code	HCPCS J1561
Min. Negotiated Rate	$49.73
Max. Negotiated Rate	$119.00
Rate for Payer: AlohaCare Medicare	$49.73
Rate for Payer: Cash Price	$91.00
Rate for Payer: Cash Price	$91.00
Rate for Payer: Devoted Health Medicare	$54.70
Rate for Payer: Hawaii Medical Service Association Medicare	$49.73
Rate for Payer: Hawaii Western Management Group Commercial	$72.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$59.68
Rate for Payer: Kaiser Permanente Medicaid	$59.68
Rate for Payer: Kaiser Permanente Medicare	$59.68
Rate for Payer: Ohana Health Plan Medicare	$49.73
Rate for Payer: UnitedHealthcare Medicare	$49.73

INJECTION INTERFERON ALFA-2B RECOMBINANT 1 M U

Professional

Both

$100.00

Service Code	HCPCS J9214
Min. Negotiated Rate	$16.76
Max. Negotiated Rate	$85.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Hawaii Western Management Group Commercial	$16.76
Rate for Payer: Health Management Network Commercial	$85.00

INJECTION IPILIMUMAB 1 MG

Professional

Both

$482.00

Service Code	HCPCS J9228
Min. Negotiated Rate	$187.17
Max. Negotiated Rate	$409.70
Rate for Payer: AlohaCare Medicare	$187.17
Rate for Payer: Cash Price	$313.30
Rate for Payer: Cash Price	$313.30
Rate for Payer: Devoted Health Medicare	$205.89
Rate for Payer: Hawaii Medical Service Association Medicare	$187.17
Rate for Payer: Health Management Network Commercial	$409.70
Rate for Payer: Kaiser Permanente Commercial	$224.60
Rate for Payer: Kaiser Permanente Medicaid	$224.60
Rate for Payer: Kaiser Permanente Medicare	$224.60
Rate for Payer: Ohana Health Plan Medicare	$187.17
Rate for Payer: UnitedHealthcare Medicare	$187.17

INJECTION IRINOTECAN 20 MG

Professional

Both

$142.00

Service Code	HCPCS J9206
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$177.34
Rate for Payer: AlohaCare Medicare	$1.53
Rate for Payer: Cash Price	$92.30
Rate for Payer: Cash Price	$92.30
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.53
Rate for Payer: Hawaii Western Management Group Commercial	$177.34
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$1.84
Rate for Payer: Kaiser Permanente Medicaid	$1.84
Rate for Payer: Kaiser Permanente Medicare	$1.84
Rate for Payer: Ohana Health Plan Medicare	$1.53
Rate for Payer: UnitedHealthcare Medicare	$1.53

INJECTION IRINOTECAN LIPOSOME 1 MG

Professional

Both

$172.00

Service Code	HCPCS J9205
Min. Negotiated Rate	$66.37
Max. Negotiated Rate	$146.20
Rate for Payer: AlohaCare Medicare	$66.37
Rate for Payer: Cash Price	$111.80
Rate for Payer: Cash Price	$111.80
Rate for Payer: Devoted Health Medicare	$73.01
Rate for Payer: Hawaii Medical Service Association Medicare	$66.37
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: Kaiser Permanente Commercial	$79.64
Rate for Payer: Kaiser Permanente Medicaid	$79.64
Rate for Payer: Kaiser Permanente Medicare	$79.64
Rate for Payer: Ohana Health Plan Medicare	$66.37
Rate for Payer: UnitedHealthcare Medicare	$66.37

INJECTION IRON DEXTRAN 50 MG

Professional

Both

$45.00

Service Code	HCPCS J1750
Min. Negotiated Rate	$18.11
Max. Negotiated Rate	$39.60
Rate for Payer: AlohaCare Medicare	$18.11
Rate for Payer: Cash Price	$29.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Devoted Health Medicare	$19.92
Rate for Payer: Hawaii Medical Service Association Medicare	$18.11
Rate for Payer: Hawaii Western Management Group Commercial	$39.60
Rate for Payer: Health Management Network Commercial	$38.25
Rate for Payer: Kaiser Permanente Commercial	$21.73
Rate for Payer: Kaiser Permanente Medicaid	$21.73
Rate for Payer: Kaiser Permanente Medicare	$21.73
Rate for Payer: Ohana Health Plan Medicare	$18.11
Rate for Payer: UnitedHealthcare Medicare	$18.11

INJECTION IRON SUCROSE 1 MG

Professional

Both

$1.00

Service Code	HCPCS J1756
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$10.80
Rate for Payer: AlohaCare Medicare	$0.22
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cash Price	$0.65
Rate for Payer: Devoted Health Medicare	$0.24
Rate for Payer: Hawaii Medical Service Association Medicare	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$10.80
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.26
Rate for Payer: Kaiser Permanente Medicaid	$0.26
Rate for Payer: Kaiser Permanente Medicare	$0.26
Rate for Payer: Ohana Health Plan Medicare	$0.22
Rate for Payer: UnitedHealthcare Medicare	$0.22

INJECTION IXABEPILONE 1 MG

Professional

Both

$340.00

Service Code	HCPCS J9207
Min. Negotiated Rate	$139.75
Max. Negotiated Rate	$289.00
Rate for Payer: AlohaCare Medicare	$139.75
Rate for Payer: Cash Price	$221.00
Rate for Payer: Cash Price	$221.00
Rate for Payer: Devoted Health Medicare	$153.72
Rate for Payer: Hawaii Medical Service Association Medicare	$139.75
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Kaiser Permanente Commercial	$167.70
Rate for Payer: Kaiser Permanente Medicaid	$167.70
Rate for Payer: Kaiser Permanente Medicare	$167.70
Rate for Payer: Ohana Health Plan Medicare	$139.75
Rate for Payer: UnitedHealthcare Medicare	$139.75

INJECTION KETOROLAC TROMETHAMINE PER 15 MG

Professional

Both

$8.00

Service Code	HCPCS J1885
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$13.19
Rate for Payer: AlohaCare Medicare	$0.34
Rate for Payer: Cash Price	$5.20
Rate for Payer: Cash Price	$5.20
Rate for Payer: Devoted Health Medicare	$0.37
Rate for Payer: Hawaii Medical Service Association Medicare	$0.34
Rate for Payer: Hawaii Western Management Group Commercial	$13.19
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$0.41
Rate for Payer: Kaiser Permanente Medicaid	$0.41
Rate for Payer: Kaiser Permanente Medicare	$0.41
Rate for Payer: Ohana Health Plan Medicare	$0.34
Rate for Payer: UnitedHealthcare Medicare	$0.34

INJECTION LANREOTIDE 1 MG

Professional

Both

$200.00

Service Code	HCPCS J1930
Min. Negotiated Rate	$35.72
Max. Negotiated Rate	$170.00
Rate for Payer: AlohaCare Medicare	$35.72
Rate for Payer: Cash Price	$130.00
Rate for Payer: Cash Price	$130.00
Rate for Payer: Devoted Health Medicare	$39.29
Rate for Payer: Hawaii Medical Service Association Medicare	$35.72
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$42.86
Rate for Payer: Kaiser Permanente Medicaid	$42.86
Rate for Payer: Kaiser Permanente Medicare	$42.86
Rate for Payer: Ohana Health Plan Medicare	$35.72
Rate for Payer: UnitedHealthcare Medicare	$35.72

INJECTION LEUCOVORIN CALCIUM PER 50 MG

Professional

Both

$12.00

Service Code	HCPCS J0640
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$10.20
Rate for Payer: AlohaCare Medicare	$3.59
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$3.95
Rate for Payer: Hawaii Medical Service Association Medicare	$3.59
Rate for Payer: Hawaii Western Management Group Commercial	$4.38
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$4.31
Rate for Payer: Kaiser Permanente Medicaid	$4.31
Rate for Payer: Kaiser Permanente Medicare	$4.31
Rate for Payer: Ohana Health Plan Medicare	$3.59
Rate for Payer: UnitedHealthcare Medicare	$3.59

INJECTION LEUPROLIDE ACETATE PER 3.75 MG

Professional

Both

$3,800.00

Service Code	HCPCS J1950
Min. Negotiated Rate	$265.00
Max. Negotiated Rate	$3,230.00
Rate for Payer: AlohaCare Medicare	$1,765.57
Rate for Payer: Cash Price	$2,470.00
Rate for Payer: Cash Price	$2,470.00
Rate for Payer: Devoted Health Medicare	$1,942.13
Rate for Payer: Hawaii Medical Service Association Medicare	$1,765.57
Rate for Payer: Hawaii Western Management Group Commercial	$265.00
Rate for Payer: Health Management Network Commercial	$3,230.00
Rate for Payer: Kaiser Permanente Commercial	$2,118.68
Rate for Payer: Kaiser Permanente Medicaid	$2,118.68
Rate for Payer: Kaiser Permanente Medicare	$2,118.68
Rate for Payer: Ohana Health Plan Medicare	$1,765.57
Rate for Payer: UnitedHealthcare Medicare	$1,765.57

INJECTION LEVOLEUCOVORIN NOS 0.5 MG

Professional

Both

$1.00

Service Code	HCPCS J0641
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.85
Rate for Payer: AlohaCare Medicare	$0.05
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cash Price	$0.65
Rate for Payer: Devoted Health Medicare	$0.06
Rate for Payer: Hawaii Medical Service Association Medicare	$0.05
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.06
Rate for Payer: Kaiser Permanente Medicaid	$0.06
Rate for Payer: Kaiser Permanente Medicare	$0.06
Rate for Payer: Ohana Health Plan Medicare	$0.05
Rate for Payer: UnitedHealthcare Medicare	$0.05

INJECTION LORAZEPAM 2 MG

Professional

Both

$13.00

Service Code	HCPCS J2060
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$18.02
Rate for Payer: AlohaCare Medicare	$1.66
Rate for Payer: Cash Price	$8.45
Rate for Payer: Cash Price	$8.45
Rate for Payer: Devoted Health Medicare	$1.83
Rate for Payer: Hawaii Medical Service Association Medicare	$1.66
Rate for Payer: Hawaii Western Management Group Commercial	$18.02
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$1.99
Rate for Payer: Kaiser Permanente Medicaid	$1.99
Rate for Payer: Kaiser Permanente Medicare	$1.99
Rate for Payer: Ohana Health Plan Medicare	$1.66
Rate for Payer: UnitedHealthcare Medicare	$1.66

INJECTION LURBINECTEDIN 0.1 MG

Professional

Both

$540.00

Service Code	HCPCS J9223
Min. Negotiated Rate	$212.10
Max. Negotiated Rate	$459.00
Rate for Payer: AlohaCare Medicare	$212.10
Rate for Payer: Cash Price	$351.00
Rate for Payer: Cash Price	$351.00
Rate for Payer: Devoted Health Medicare	$233.31
Rate for Payer: Hawaii Medical Service Association Medicare	$212.10
Rate for Payer: Health Management Network Commercial	$459.00
Rate for Payer: Kaiser Permanente Commercial	$254.52
Rate for Payer: Kaiser Permanente Medicaid	$254.52
Rate for Payer: Kaiser Permanente Medicare	$254.52
Rate for Payer: Ohana Health Plan Medicare	$212.10
Rate for Payer: UnitedHealthcare Medicare	$212.10

INJECTION LUSPATERCEPT-AAMT 0.25 MG

Professional

Both

$112.00

Service Code	HCPCS J0896
Min. Negotiated Rate	$42.75
Max. Negotiated Rate	$95.20
Rate for Payer: AlohaCare Medicare	$42.75
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cash Price	$72.80
Rate for Payer: Devoted Health Medicare	$47.02
Rate for Payer: Hawaii Medical Service Association Medicare	$42.75
Rate for Payer: Health Management Network Commercial	$95.20
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: Kaiser Permanente Medicaid	$51.30
Rate for Payer: Kaiser Permanente Medicare	$51.30
Rate for Payer: Ohana Health Plan Medicare	$42.75
Rate for Payer: UnitedHealthcare Medicare	$42.75

INJECTION MAGNESIUM SULPHATE PER 500 MG

Professional

Both

$2.00

Service Code	HCPCS J3475
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$1.70
Rate for Payer: AlohaCare Medicare	$0.43
Rate for Payer: Cash Price	$1.30
Rate for Payer: Cash Price	$1.30
Rate for Payer: Devoted Health Medicare	$0.47
Rate for Payer: Hawaii Medical Service Association Medicare	$0.43
Rate for Payer: Hawaii Western Management Group Commercial	$1.55
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$0.52
Rate for Payer: Kaiser Permanente Medicaid	$0.52
Rate for Payer: Kaiser Permanente Medicare	$0.52
Rate for Payer: Ohana Health Plan Medicare	$0.43
Rate for Payer: UnitedHealthcare Medicare	$0.43

INJECTION MANNITOL 25% IN 50 ML

Professional

Both

$12.00

Service Code	HCPCS J2150
Min. Negotiated Rate	$7.13
Max. Negotiated Rate	$10.20
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$7.80
Rate for Payer: Hawaii Western Management Group Commercial	$7.13
Rate for Payer: Health Management Network Commercial	$10.20

Know your out-of-pocket cost for care.

All Charges