Kona Community Hospital

All Charges

Charge

Type

Setting

Price

INJECTION MARGETUXIMAB-CMKB 5 MG

Professional

Both

$135.00

Service Code	HCPCS J9353
Min. Negotiated Rate	$53.27
Max. Negotiated Rate	$114.75
Rate for Payer: AlohaCare Medicare	$53.27
Rate for Payer: Cash Price	$87.75
Rate for Payer: Cash Price	$87.75
Rate for Payer: Devoted Health Medicare	$58.60
Rate for Payer: Hawaii Medical Service Association Medicare	$53.27
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Kaiser Permanente Commercial	$63.92
Rate for Payer: Kaiser Permanente Medicaid	$63.92
Rate for Payer: Kaiser Permanente Medicare	$63.92
Rate for Payer: Ohana Health Plan Medicare	$53.27
Rate for Payer: UnitedHealthcare Medicare	$53.27

INJECTION MEPERIDINE HCL PER 100 MG

Professional

Both

$19.00

Service Code	HCPCS J2175
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$16.15
Rate for Payer: AlohaCare Medicare	$8.82
Rate for Payer: Cash Price	$12.35
Rate for Payer: Cash Price	$12.35
Rate for Payer: Devoted Health Medicare	$9.70
Rate for Payer: Hawaii Medical Service Association Medicare	$8.82
Rate for Payer: Hawaii Western Management Group Commercial	$1.42
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Kaiser Permanente Commercial	$10.58
Rate for Payer: Kaiser Permanente Medicaid	$10.58
Rate for Payer: Kaiser Permanente Medicare	$10.58
Rate for Payer: Ohana Health Plan Medicare	$8.82
Rate for Payer: UnitedHealthcare Medicare	$8.82

INJECTION MESNA 200 MG

Professional

Both

$43.00

Service Code	HCPCS J9209
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$53.33
Rate for Payer: AlohaCare Medicare	$1.33
Rate for Payer: Cash Price	$27.95
Rate for Payer: Cash Price	$27.95
Rate for Payer: Devoted Health Medicare	$1.46
Rate for Payer: Hawaii Medical Service Association Medicare	$1.33
Rate for Payer: Hawaii Western Management Group Commercial	$53.33
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Kaiser Permanente Commercial	$1.60
Rate for Payer: Kaiser Permanente Medicaid	$1.60
Rate for Payer: Kaiser Permanente Medicare	$1.60
Rate for Payer: Ohana Health Plan Medicare	$1.33
Rate for Payer: UnitedHealthcare Medicare	$1.33

INJECTION MITOMYCIN 5 MG

Professional

Both

$152.00

Service Code	HCPCS J9280
Min. Negotiated Rate	$28.46
Max. Negotiated Rate	$129.20
Rate for Payer: AlohaCare Medicare	$28.46
Rate for Payer: Cash Price	$98.80
Rate for Payer: Cash Price	$98.80
Rate for Payer: Devoted Health Medicare	$31.31
Rate for Payer: Hawaii Medical Service Association Medicare	$28.46
Rate for Payer: Hawaii Western Management Group Commercial	$98.00
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$34.15
Rate for Payer: Kaiser Permanente Medicaid	$34.15
Rate for Payer: Kaiser Permanente Medicare	$34.15
Rate for Payer: Ohana Health Plan Medicare	$28.46
Rate for Payer: UnitedHealthcare Medicare	$28.46

INJECTION MITOXANTRONE HCL PER 5 MG

Professional

Both

$258.00

Service Code	HCPCS J9293
Min. Negotiated Rate	$38.61
Max. Negotiated Rate	$250.31
Rate for Payer: AlohaCare Medicare	$38.61
Rate for Payer: Cash Price	$167.70
Rate for Payer: Cash Price	$167.70
Rate for Payer: Devoted Health Medicare	$42.47
Rate for Payer: Hawaii Medical Service Association Medicare	$38.61
Rate for Payer: Hawaii Western Management Group Commercial	$250.31
Rate for Payer: Health Management Network Commercial	$219.30
Rate for Payer: Kaiser Permanente Commercial	$46.33
Rate for Payer: Kaiser Permanente Medicaid	$46.33
Rate for Payer: Kaiser Permanente Medicare	$46.33
Rate for Payer: Ohana Health Plan Medicare	$38.61
Rate for Payer: UnitedHealthcare Medicare	$38.61

INJECTION MOGAMULIZUMAB-KPKC 1 MG

Professional

Both

$640.00

Service Code	HCPCS J9204
Min. Negotiated Rate	$253.47
Max. Negotiated Rate	$544.00
Rate for Payer: AlohaCare Medicare	$253.47
Rate for Payer: Cash Price	$416.00
Rate for Payer: Cash Price	$416.00
Rate for Payer: Devoted Health Medicare	$278.82
Rate for Payer: Hawaii Medical Service Association Medicare	$253.47
Rate for Payer: Health Management Network Commercial	$544.00
Rate for Payer: Kaiser Permanente Commercial	$304.16
Rate for Payer: Kaiser Permanente Medicaid	$304.16
Rate for Payer: Kaiser Permanente Medicare	$304.16
Rate for Payer: Ohana Health Plan Medicare	$253.47
Rate for Payer: UnitedHealthcare Medicare	$253.47

INJECTION NIVOLUMAB 1 MG

Professional

Both

$88.00

Service Code	HCPCS J9299
Min. Negotiated Rate	$26.68
Max. Negotiated Rate	$74.80
Rate for Payer: AlohaCare Medicare	$33.62
Rate for Payer: Cash Price	$57.20
Rate for Payer: Cash Price	$57.20
Rate for Payer: Devoted Health Medicare	$36.98
Rate for Payer: Hawaii Medical Service Association Medicare	$33.62
Rate for Payer: Hawaii Western Management Group Commercial	$26.68
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Kaiser Permanente Commercial	$40.34
Rate for Payer: Kaiser Permanente Medicaid	$40.34
Rate for Payer: Kaiser Permanente Medicare	$40.34
Rate for Payer: Ohana Health Plan Medicare	$33.62
Rate for Payer: UnitedHealthcare Medicare	$33.62

INJECTION OBINUTUZUMAB 10 MG

Professional

Both

$192.00

Service Code	HCPCS J9301
Min. Negotiated Rate	$55.73
Max. Negotiated Rate	$163.20
Rate for Payer: AlohaCare Medicare	$81.81
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cash Price	$124.80
Rate for Payer: Devoted Health Medicare	$89.99
Rate for Payer: Hawaii Medical Service Association Medicare	$81.81
Rate for Payer: Hawaii Western Management Group Commercial	$55.73
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Kaiser Permanente Commercial	$98.17
Rate for Payer: Kaiser Permanente Medicaid	$98.17
Rate for Payer: Kaiser Permanente Medicare	$98.17
Rate for Payer: Ohana Health Plan Medicare	$81.81
Rate for Payer: UnitedHealthcare Medicare	$81.81

INJECTION OFATUMUMAB 10 MG

Professional

Both

$192.00

Service Code	HCPCS J9302
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$163.20
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$163.20

INJECTION ONDANSETRON HCL PER 1 MG

Professional

Both

$7.00

Service Code	HCPCS J2405
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$9.34
Rate for Payer: AlohaCare Medicare	$0.09
Rate for Payer: Cash Price	$4.55
Rate for Payer: Cash Price	$4.55
Rate for Payer: Devoted Health Medicare	$0.10
Rate for Payer: Hawaii Medical Service Association Medicare	$0.09
Rate for Payer: Hawaii Western Management Group Commercial	$9.34
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$0.11
Rate for Payer: Kaiser Permanente Medicaid	$0.11
Rate for Payer: Kaiser Permanente Medicare	$0.11
Rate for Payer: Ohana Health Plan Medicare	$0.09
Rate for Payer: UnitedHealthcare Medicare	$0.09

INJECTION OXALIPLATIN 0.5 MG

Professional

Both

$1.00

Service Code	HCPCS J9263
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.94
Rate for Payer: AlohaCare Medicare	$0.08
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cash Price	$0.65
Rate for Payer: Devoted Health Medicare	$0.09
Rate for Payer: Hawaii Medical Service Association Medicare	$0.08
Rate for Payer: Hawaii Western Management Group Commercial	$0.94
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.10
Rate for Payer: Kaiser Permanente Medicaid	$0.10
Rate for Payer: Kaiser Permanente Medicare	$0.10
Rate for Payer: Ohana Health Plan Medicare	$0.08
Rate for Payer: UnitedHealthcare Medicare	$0.08

INJECTION PACLITAXEL 1 MG

Professional

Both

$1.00

Service Code	HCPCS J9267
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.85
Rate for Payer: AlohaCare Medicare	$0.15
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cash Price	$0.65
Rate for Payer: Devoted Health Medicare	$0.17
Rate for Payer: Hawaii Medical Service Association Medicare	$0.15
Rate for Payer: Hawaii Western Management Group Commercial	$0.46
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.18
Rate for Payer: Kaiser Permanente Medicaid	$0.18
Rate for Payer: Kaiser Permanente Medicare	$0.18
Rate for Payer: Ohana Health Plan Medicare	$0.15
Rate for Payer: UnitedHealthcare Medicare	$0.15

INJECTION PACLITAXEL PROTEINBOUND PARTICLES 1 MG

Professional

Both

$42.00

Service Code	HCPCS J9264
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$35.70
Rate for Payer: AlohaCare Medicare	$6.02
Rate for Payer: Cash Price	$27.30
Rate for Payer: Cash Price	$27.30
Rate for Payer: Devoted Health Medicare	$6.62
Rate for Payer: Hawaii Medical Service Association Medicare	$6.02
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: Kaiser Permanente Commercial	$7.22
Rate for Payer: Kaiser Permanente Medicaid	$7.22
Rate for Payer: Kaiser Permanente Medicare	$7.22
Rate for Payer: Ohana Health Plan Medicare	$6.02
Rate for Payer: UnitedHealthcare Medicare	$6.02

INJECTION PALONOSETRON HCL 25 MCG

Professional

Both

$3.00

Service Code	HCPCS J2469
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$40.93
Rate for Payer: AlohaCare Medicare	$0.65
Rate for Payer: Cash Price	$1.95
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$0.72
Rate for Payer: Hawaii Medical Service Association Medicare	$0.65
Rate for Payer: Hawaii Western Management Group Commercial	$40.93
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$0.78
Rate for Payer: Kaiser Permanente Medicaid	$0.78
Rate for Payer: Kaiser Permanente Medicare	$0.78
Rate for Payer: Ohana Health Plan Medicare	$0.65
Rate for Payer: UnitedHealthcare Medicare	$0.65

INJECTION PAMIDRONATE DISODIUM PER 30 MG

Professional

Both

$280.00

Service Code	HCPCS J2430
Min. Negotiated Rate	$12.42
Max. Negotiated Rate	$301.92
Rate for Payer: AlohaCare Medicare	$12.42
Rate for Payer: Cash Price	$182.00
Rate for Payer: Cash Price	$182.00
Rate for Payer: Devoted Health Medicare	$13.66
Rate for Payer: Hawaii Medical Service Association Medicare	$12.42
Rate for Payer: Hawaii Western Management Group Commercial	$301.92
Rate for Payer: Health Management Network Commercial	$238.00
Rate for Payer: Kaiser Permanente Commercial	$14.90
Rate for Payer: Kaiser Permanente Medicaid	$14.90
Rate for Payer: Kaiser Permanente Medicare	$14.90
Rate for Payer: Ohana Health Plan Medicare	$12.42
Rate for Payer: UnitedHealthcare Medicare	$12.42

INJECTION PANITUMUMAB 10 MG

Professional

Both

$390.00

Service Code	HCPCS J9303
Min. Negotiated Rate	$106.99
Max. Negotiated Rate	$331.50
Rate for Payer: AlohaCare Medicare	$174.39
Rate for Payer: Cash Price	$253.50
Rate for Payer: Cash Price	$253.50
Rate for Payer: Devoted Health Medicare	$191.83
Rate for Payer: Hawaii Medical Service Association Medicare	$174.39
Rate for Payer: Hawaii Western Management Group Commercial	$106.99
Rate for Payer: Health Management Network Commercial	$331.50
Rate for Payer: Kaiser Permanente Commercial	$209.27
Rate for Payer: Kaiser Permanente Medicaid	$209.27
Rate for Payer: Kaiser Permanente Medicare	$209.27
Rate for Payer: Ohana Health Plan Medicare	$174.39
Rate for Payer: UnitedHealthcare Medicare	$174.39

INJECTION PEGFILGRASTIM-CBQV BIOSIMILAR 0.5 MG

Professional

Both

$500.00

Service Code	HCPCS Q5111
Min. Negotiated Rate	$135.89
Max. Negotiated Rate	$425.00
Rate for Payer: AlohaCare Medicare	$135.89
Rate for Payer: Cash Price	$325.00
Rate for Payer: Cash Price	$325.00
Rate for Payer: Devoted Health Medicare	$149.48
Rate for Payer: Hawaii Medical Service Association Medicare	$135.89
Rate for Payer: Health Management Network Commercial	$425.00
Rate for Payer: Kaiser Permanente Commercial	$163.07
Rate for Payer: Kaiser Permanente Medicaid	$163.07
Rate for Payer: Kaiser Permanente Medicare	$163.07
Rate for Payer: Ohana Health Plan Medicare	$135.89
Rate for Payer: UnitedHealthcare Medicare	$135.89

INJECTION PEGFILGRASTIM-JMDB BIOSIMILAR 0.5 MG

Professional

Both

$450.00

Service Code	HCPCS Q5108
Min. Negotiated Rate	$79.50
Max. Negotiated Rate	$382.50
Rate for Payer: AlohaCare Medicare	$79.50
Rate for Payer: Cash Price	$292.50
Rate for Payer: Cash Price	$292.50
Rate for Payer: Devoted Health Medicare	$87.45
Rate for Payer: Hawaii Medical Service Association Medicare	$79.50
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Kaiser Permanente Commercial	$95.40
Rate for Payer: Kaiser Permanente Medicaid	$95.40
Rate for Payer: Kaiser Permanente Medicare	$95.40
Rate for Payer: Ohana Health Plan Medicare	$79.50
Rate for Payer: UnitedHealthcare Medicare	$79.50

INJECTION PEMBROLIZUMAB 1 MG

Professional

Both

$157.00

Service Code	HCPCS J9271
Min. Negotiated Rate	$49.47
Max. Negotiated Rate	$133.45
Rate for Payer: AlohaCare Medicare	$61.25
Rate for Payer: Cash Price	$102.05
Rate for Payer: Cash Price	$102.05
Rate for Payer: Devoted Health Medicare	$67.38
Rate for Payer: Hawaii Medical Service Association Medicare	$61.25
Rate for Payer: Hawaii Western Management Group Commercial	$49.47
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: Kaiser Permanente Commercial	$73.50
Rate for Payer: Kaiser Permanente Medicaid	$73.50
Rate for Payer: Kaiser Permanente Medicare	$73.50
Rate for Payer: Ohana Health Plan Medicare	$61.25
Rate for Payer: UnitedHealthcare Medicare	$61.25

INJECTION PEMETREXED NOS10 MG

Professional

Both

$230.00

Service Code	HCPCS J9305
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$195.50
Rate for Payer: AlohaCare Medicare	$4.04
Rate for Payer: Cash Price	$149.50
Rate for Payer: Cash Price	$149.50
Rate for Payer: Devoted Health Medicare	$4.44
Rate for Payer: Hawaii Medical Service Association Medicare	$4.04
Rate for Payer: Hawaii Western Management Group Commercial	$62.59
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Kaiser Permanente Commercial	$4.85
Rate for Payer: Kaiser Permanente Medicaid	$4.85
Rate for Payer: Kaiser Permanente Medicare	$4.85
Rate for Payer: Ohana Health Plan Medicare	$4.04
Rate for Payer: UnitedHealthcare Medicare	$4.04

INJECTION PEMETREXED PEMFEXY 10 MG

Professional

Both

$200.00

Service Code	HCPCS J9304
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$170.00
Rate for Payer: AlohaCare Medicare	$7.99
Rate for Payer: Cash Price	$130.00
Rate for Payer: Cash Price	$130.00
Rate for Payer: Devoted Health Medicare	$8.79
Rate for Payer: Hawaii Medical Service Association Medicare	$7.99
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$9.59
Rate for Payer: Kaiser Permanente Medicaid	$9.59
Rate for Payer: Kaiser Permanente Medicare	$9.59
Rate for Payer: Ohana Health Plan Medicare	$7.99
Rate for Payer: UnitedHealthcare Medicare	$7.99

INJECTION PENTOSTATIN 10 MG

Professional

Both

$5,800.00

Service Code	HCPCS J9268
Min. Negotiated Rate	$295.20
Max. Negotiated Rate	$4,930.00
Rate for Payer: AlohaCare Medicare	$2,626.33
Rate for Payer: Cash Price	$3,770.00
Rate for Payer: Cash Price	$3,770.00
Rate for Payer: Devoted Health Medicare	$2,888.96
Rate for Payer: Hawaii Medical Service Association Medicare	$2,626.33
Rate for Payer: Hawaii Western Management Group Commercial	$295.20
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Kaiser Permanente Commercial	$3,151.60
Rate for Payer: Kaiser Permanente Medicaid	$3,151.60
Rate for Payer: Kaiser Permanente Medicare	$3,151.60
Rate for Payer: Ohana Health Plan Medicare	$2,626.33
Rate for Payer: UnitedHealthcare Medicare	$2,626.33

INJECTION PERTUZUMAB 1 MG

Professional

Both

$40.00

Service Code	HCPCS J9306
Min. Negotiated Rate	$17.02
Max. Negotiated Rate	$34.00
Rate for Payer: AlohaCare Medicare	$17.02
Rate for Payer: Cash Price	$26.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Devoted Health Medicare	$18.72
Rate for Payer: Hawaii Medical Service Association Medicare	$17.02
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Kaiser Permanente Commercial	$20.42
Rate for Payer: Kaiser Permanente Medicaid	$20.42
Rate for Payer: Kaiser Permanente Medicare	$20.42
Rate for Payer: Ohana Health Plan Medicare	$17.02
Rate for Payer: UnitedHealthcare Medicare	$17.02

INJECTION POLATUZUMAB VEDOTIN-PIIQ 1 MG

Professional

Both

$340.00

Service Code	HCPCS J9309
Min. Negotiated Rate	$137.23
Max. Negotiated Rate	$289.00
Rate for Payer: AlohaCare Medicare	$137.23
Rate for Payer: Cash Price	$221.00
Rate for Payer: Cash Price	$221.00
Rate for Payer: Devoted Health Medicare	$150.95
Rate for Payer: Hawaii Medical Service Association Medicare	$137.23
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Kaiser Permanente Commercial	$164.68
Rate for Payer: Kaiser Permanente Medicaid	$164.68
Rate for Payer: Kaiser Permanente Medicare	$164.68
Rate for Payer: Ohana Health Plan Medicare	$137.23
Rate for Payer: UnitedHealthcare Medicare	$137.23

INJECTION POTASSIUM CHLORIDE PER 2 MEQ

Professional

Both

$1.00

Service Code	HCPCS J3480
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.85
Rate for Payer: AlohaCare Medicare	$0.13
Rate for Payer: Cash Price	$0.65
Rate for Payer: Cash Price	$0.65
Rate for Payer: Devoted Health Medicare	$0.14
Rate for Payer: Hawaii Medical Service Association Medicare	$0.13
Rate for Payer: Hawaii Western Management Group Commercial	$0.40
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.16
Rate for Payer: Kaiser Permanente Medicaid	$0.16
Rate for Payer: Kaiser Permanente Medicare	$0.16
Rate for Payer: Ohana Health Plan Medicare	$0.13
Rate for Payer: UnitedHealthcare Medicare	$0.13

Know your out-of-pocket cost for care.

All Charges