Kona Community Hospital

All Charges

Charge

Type

Setting

Price

DOXAZOSIN 1 MG PO TABLET

Facility

$4.69

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$4.55
Rate for Payer: Cash Price	$3.05
Rate for Payer: Health Management Network Commercial	$3.99
Rate for Payer: MDX Hawaii PPO	$4.55

DOXAZOSIN 1 MG PO TABLET

Facility

$4.69

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$4.55
Rate for Payer: Cash Price	$3.05
Rate for Payer: Hawaii Western Management Group Commercial	$4.46
Rate for Payer: Health Management Network Commercial	$3.99
Rate for Payer: Kaiser Permanente Commercial	$2.95
Rate for Payer: Kaiser Permanente Medicaid	$2.39
Rate for Payer: MDX Hawaii PPO	$4.55
Rate for Payer: UnitedHealthcare Medicaid	$2.81
Rate for Payer: University Health Alliance Commercial	$3.42

DOXAZOSIN 4 MG PO TABLET

Facility

$7.82

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$7.59
Rate for Payer: Cash Price	$5.08
Rate for Payer: Hawaii Western Management Group Commercial	$7.43
Rate for Payer: Health Management Network Commercial	$6.65
Rate for Payer: Kaiser Permanente Commercial	$4.93
Rate for Payer: Kaiser Permanente Medicaid	$3.99
Rate for Payer: MDX Hawaii PPO	$7.59
Rate for Payer: UnitedHealthcare Medicaid	$4.69
Rate for Payer: University Health Alliance Commercial	$5.70

DOXAZOSIN 4 MG PO TABLET

Facility

$7.82

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$7.59
Rate for Payer: Cash Price	$5.08
Rate for Payer: Health Management Network Commercial	$6.65
Rate for Payer: MDX Hawaii PPO	$7.59

DOXEPIN 10 MG PO CAP

Facility

$3.45

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$3.35
Rate for Payer: Cash Price	$2.24
Rate for Payer: Health Management Network Commercial	$2.93
Rate for Payer: MDX Hawaii PPO	$3.35

DOXEPIN 10 MG PO CAP

Facility

$3.45

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$3.35
Rate for Payer: Cash Price	$2.24
Rate for Payer: Hawaii Western Management Group Commercial	$3.28
Rate for Payer: Health Management Network Commercial	$2.93
Rate for Payer: Kaiser Permanente Commercial	$2.17
Rate for Payer: Kaiser Permanente Medicaid	$1.76
Rate for Payer: MDX Hawaii PPO	$3.35
Rate for Payer: UnitedHealthcare Medicaid	$2.07
Rate for Payer: University Health Alliance Commercial	$2.51

DOXEPIN 25 MG PO CAP

Facility

$4.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$4.40
Rate for Payer: Cash Price	$2.95
Rate for Payer: Cash Price	$3.03
Rate for Payer: Health Management Network Commercial	$3.96
Rate for Payer: Health Management Network Commercial	$3.86
Rate for Payer: MDX Hawaii PPO	$4.40
Rate for Payer: MDX Hawaii PPO	$4.52

DOXEPIN 25 MG PO CAP

Facility

$4.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$4.40
Rate for Payer: Cash Price	$2.95
Rate for Payer: Cash Price	$3.03
Rate for Payer: Hawaii Western Management Group Commercial	$4.31
Rate for Payer: Hawaii Western Management Group Commercial	$4.43
Rate for Payer: Health Management Network Commercial	$3.86
Rate for Payer: Health Management Network Commercial	$3.96
Rate for Payer: Kaiser Permanente Commercial	$2.86
Rate for Payer: Kaiser Permanente Commercial	$2.94
Rate for Payer: Kaiser Permanente Medicaid	$2.32
Rate for Payer: Kaiser Permanente Medicaid	$2.38
Rate for Payer: MDX Hawaii PPO	$4.40
Rate for Payer: MDX Hawaii PPO	$4.52
Rate for Payer: UnitedHealthcare Medicaid	$2.80
Rate for Payer: UnitedHealthcare Medicaid	$2.72
Rate for Payer: University Health Alliance Commercial	$3.31
Rate for Payer: University Health Alliance Commercial	$3.40

DOXEPIN 50 MG PO CAP

Facility

$6.45

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.48
Max. Negotiated Rate	$6.26
Rate for Payer: Cash Price	$4.19
Rate for Payer: Cash Price	$4.23
Rate for Payer: Health Management Network Commercial	$5.53
Rate for Payer: Health Management Network Commercial	$5.48
Rate for Payer: MDX Hawaii PPO	$6.26
Rate for Payer: MDX Hawaii PPO	$6.30

DOXEPIN 50 MG PO CAP

Facility

$6.45

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$6.26
Rate for Payer: Cash Price	$4.19
Rate for Payer: Cash Price	$4.23
Rate for Payer: Hawaii Western Management Group Commercial	$6.13
Rate for Payer: Hawaii Western Management Group Commercial	$6.17
Rate for Payer: Health Management Network Commercial	$5.48
Rate for Payer: Health Management Network Commercial	$5.53
Rate for Payer: Kaiser Permanente Commercial	$4.06
Rate for Payer: Kaiser Permanente Commercial	$4.09
Rate for Payer: Kaiser Permanente Medicaid	$3.31
Rate for Payer: Kaiser Permanente Medicaid	$3.29
Rate for Payer: MDX Hawaii PPO	$6.26
Rate for Payer: MDX Hawaii PPO	$6.30
Rate for Payer: UnitedHealthcare Medicaid	$3.90
Rate for Payer: UnitedHealthcare Medicaid	$3.87
Rate for Payer: University Health Alliance Commercial	$4.70
Rate for Payer: University Health Alliance Commercial	$4.74

DOXORUBICIN 10 MG/5 ML IV SOLN

Facility

$58.69

Service Code	HCPCS J9000
Hospital Revenue Code	250
Min. Negotiated Rate	$49.89
Max. Negotiated Rate	$56.93
Rate for Payer: Cash Price	$38.15
Rate for Payer: Health Management Network Commercial	$49.89
Rate for Payer: MDX Hawaii PPO	$56.93

DOXORUBICIN 10 MG/5 ML IV SOLN

Facility

$58.69

Service Code	HCPCS J9000
Hospital Revenue Code	636
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$56.93
Rate for Payer: Cash Price	$38.15
Rate for Payer: Cash Price	$38.15
Rate for Payer: Hawaii Medical Service Association ABD	$2.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.72
Rate for Payer: Hawaii Western Management Group Commercial	$55.76
Rate for Payer: Health Management Network Commercial	$49.89
Rate for Payer: Kaiser Permanente Commercial	$36.97
Rate for Payer: Kaiser Permanente Medicaid	$29.93
Rate for Payer: MDX Hawaii PPO	$56.93
Rate for Payer: UnitedHealthcare Medicaid	$35.21
Rate for Payer: University Health Alliance Commercial	$42.78

DOXORUBICIN 20 MG/10 ML IV SOLN

Facility

$102.05

Service Code	HCPCS J9000
Hospital Revenue Code	636
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$98.99
Rate for Payer: Cash Price	$66.33
Rate for Payer: Cash Price	$66.33
Rate for Payer: Hawaii Medical Service Association ABD	$2.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.72
Rate for Payer: Hawaii Western Management Group Commercial	$96.95
Rate for Payer: Health Management Network Commercial	$86.74
Rate for Payer: Kaiser Permanente Commercial	$64.29
Rate for Payer: Kaiser Permanente Medicaid	$52.05
Rate for Payer: MDX Hawaii PPO	$98.99
Rate for Payer: UnitedHealthcare Medicaid	$61.23
Rate for Payer: University Health Alliance Commercial	$74.38

DOXORUBICIN 20 MG/10 ML IV SOLN

Facility

$102.05

Service Code	HCPCS J9000
Hospital Revenue Code	250
Min. Negotiated Rate	$86.74
Max. Negotiated Rate	$98.99
Rate for Payer: Cash Price	$66.33
Rate for Payer: Health Management Network Commercial	$86.74
Rate for Payer: MDX Hawaii PPO	$98.99

DOXORUBICIN 50 MG/25 ML IV SOLN

Facility

$155.97

Service Code	HCPCS J9000
Hospital Revenue Code	636
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$151.29
Rate for Payer: Cash Price	$101.38
Rate for Payer: Cash Price	$101.38
Rate for Payer: Hawaii Medical Service Association ABD	$2.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.72
Rate for Payer: Hawaii Western Management Group Commercial	$148.17
Rate for Payer: Health Management Network Commercial	$132.57
Rate for Payer: Kaiser Permanente Commercial	$98.26
Rate for Payer: Kaiser Permanente Medicaid	$79.54
Rate for Payer: MDX Hawaii PPO	$151.29
Rate for Payer: UnitedHealthcare Medicaid	$93.58
Rate for Payer: University Health Alliance Commercial	$113.69

DOXORUBICIN 50 MG/25 ML IV SOLN

Facility

$155.97

Service Code	HCPCS J9000
Hospital Revenue Code	250
Min. Negotiated Rate	$132.57
Max. Negotiated Rate	$151.29
Rate for Payer: Cash Price	$101.38
Rate for Payer: Health Management Network Commercial	$132.57
Rate for Payer: MDX Hawaii PPO	$151.29

DOXORUBICIN, PEG-LIPOSOMAL 2 MG/ML IV SUSP

Facility

$2,513.76

Service Code	HCPCS Q2050
Hospital Revenue Code	250
Min. Negotiated Rate	$2,136.70
Max. Negotiated Rate	$2,438.35
Rate for Payer: Cash Price	$1,633.94
Rate for Payer: Health Management Network Commercial	$2,136.70
Rate for Payer: MDX Hawaii PPO	$2,438.35

DOXORUBICIN, PEG-LIPOSOMAL 2 MG/ML IV SUSP

Facility

$2,513.76

Service Code	HCPCS Q2050
Hospital Revenue Code	250
Min. Negotiated Rate	$71.86
Max. Negotiated Rate	$2,438.35
Rate for Payer: AlohaCare Medicaid	$71.86
Rate for Payer: AlohaCare Medicare	$71.86
Rate for Payer: Cash Price	$1,633.94
Rate for Payer: Cash Price	$1,633.94
Rate for Payer: Devoted Health Medicare	$79.05
Rate for Payer: Hawaii Medical Service Association ABD	$109.28
Rate for Payer: Hawaii Medical Service Association Commercial	$89.83
Rate for Payer: Hawaii Medical Service Association Medicare	$71.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$109.28
Rate for Payer: Hawaii Western Management Group Commercial	$2,388.07
Rate for Payer: Health Management Network Commercial	$2,136.70
Rate for Payer: Humana Medicare	$71.86
Rate for Payer: Kaiser Permanente Commercial	$1,583.67
Rate for Payer: Kaiser Permanente Medicaid	$1,282.02
Rate for Payer: Kaiser Permanente Medicare	$71.86
Rate for Payer: MDX Hawaii PPO	$2,438.35
Rate for Payer: Ohana Health Plan Medicaid	$79.05
Rate for Payer: Ohana Health Plan Medicare	$71.86
Rate for Payer: UnitedHealthcare Medicaid	$1,508.26
Rate for Payer: UnitedHealthcare Medicare	$71.86
Rate for Payer: University Health Alliance Commercial	$1,832.28

DOXYCYCLINE HYCLATE 100 MG IV RECON.SOLN.

Facility

$127.01

Service Code	HCPCS J1271
Hospital Revenue Code	250
Min. Negotiated Rate	$107.96
Max. Negotiated Rate	$123.20
Rate for Payer: Cash Price	$82.56
Rate for Payer: Health Management Network Commercial	$107.96
Rate for Payer: MDX Hawaii PPO	$123.20

DOXYCYCLINE HYCLATE 100 MG IV RECON.SOLN.

Facility

$127.01

Service Code	HCPCS J1271
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$123.20
Rate for Payer: Cash Price	$82.56
Rate for Payer: Cash Price	$82.56
Rate for Payer: Hawaii Medical Service Association ABD	$0.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.12
Rate for Payer: Hawaii Western Management Group Commercial	$120.66
Rate for Payer: Health Management Network Commercial	$107.96
Rate for Payer: Kaiser Permanente Commercial	$80.02
Rate for Payer: Kaiser Permanente Medicaid	$64.78
Rate for Payer: MDX Hawaii PPO	$123.20
Rate for Payer: UnitedHealthcare Medicaid	$76.21
Rate for Payer: University Health Alliance Commercial	$92.58

DOXYCYCLINE HYCLATE 100 MG PO TABLET

Facility

$30.85

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$26.22
Max. Negotiated Rate	$29.92
Rate for Payer: Cash Price	$20.05
Rate for Payer: Health Management Network Commercial	$26.22
Rate for Payer: MDX Hawaii PPO	$29.92

DOXYCYCLINE HYCLATE 100 MG PO TABLET

Facility

$30.85

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$15.73
Max. Negotiated Rate	$29.92
Rate for Payer: Cash Price	$20.05
Rate for Payer: Hawaii Western Management Group Commercial	$29.31
Rate for Payer: Health Management Network Commercial	$26.22
Rate for Payer: Kaiser Permanente Commercial	$19.44
Rate for Payer: Kaiser Permanente Medicaid	$15.73
Rate for Payer: MDX Hawaii PPO	$29.92
Rate for Payer: UnitedHealthcare Medicaid	$18.51
Rate for Payer: University Health Alliance Commercial	$22.49

DOXYCYCLINE MONOHYDRATE 25 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$112.40

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$57.32
Max. Negotiated Rate	$109.03
Rate for Payer: Cash Price	$73.06
Rate for Payer: Hawaii Western Management Group Commercial	$106.78
Rate for Payer: Health Management Network Commercial	$95.54
Rate for Payer: Kaiser Permanente Commercial	$70.81
Rate for Payer: Kaiser Permanente Medicaid	$57.32
Rate for Payer: MDX Hawaii PPO	$109.03
Rate for Payer: UnitedHealthcare Medicaid	$67.44
Rate for Payer: University Health Alliance Commercial	$81.93

DOXYCYCLINE MONOHYDRATE 25 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$112.40

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$95.54
Max. Negotiated Rate	$109.03
Rate for Payer: Cash Price	$73.06
Rate for Payer: Health Management Network Commercial	$95.54
Rate for Payer: MDX Hawaii PPO	$109.03

Drain 0070740 Bulb Jvac Reserv 100 cc [3600881]

Facility

$44.29

Hospital Charge Code	3600881
Hospital Revenue Code	272
Min. Negotiated Rate	$22.59
Max. Negotiated Rate	$42.96
Rate for Payer: Cash Price	$28.79
Rate for Payer: Hawaii Western Management Group Commercial	$42.08
Rate for Payer: Health Management Network Commercial	$37.65
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: Kaiser Permanente Medicaid	$22.59
Rate for Payer: MDX Hawaii PPO	$42.96
Rate for Payer: University Health Alliance Commercial	$32.28

Know your out-of-pocket cost for care.

All Charges