CMS Price Transparency Data

Pneumonia vaccine injection

Facility: Kona Community Hospital

Billing Code: G0009 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0009
Insurance Median: $59
Cash Discount Price: $83
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Pneumonia vaccine injection at Kona Community Hospital is $59. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $83. Compared to the federal Medicare reimbursement reference rate of $47.84, this hospital’s rate is 1.23x the Medicare baseline. Located in 79-1019 Haukapila Street, Kealakekua, HI.

Cash / Self-Pay

$83

Average discount available for prompt cash payment at this facility.

Insurance Median

$59

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$47.84

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $47.84 (100%)

Cash / Self-Pay: $83 (173%)

Insurance Median: $59 (123%)

Cash: $83 (173% of Medicare)

Ins. Median: $59 (123% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $47.84 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Hmsa	$28 - $59	59%
UnitedHealthcare	$34 - $59	71%
Humana	$55 - $59	115%
Kaiser Permanente	$55 - $89	115%
Alohacare	$55 - $59	115%
Hawaii Medical Service Association	$55 - $69	115%
Ohana Health Plan	$55 - $61	115%
Ohana	$59 - $65	123%
Kaiser	$59	123%
Devoted Health	$61	128%
University Health Alliance	$103	215%
Health Management Network	$120	251%
Hawaii Western Management Group	$134	280%
Mdx Hawaii	$137	286%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $83.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0009.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Kona Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code G0009.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.