Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

KETAMINE 50 MG/ML INJECTION SOLUTION [4238]

Facility

IP

$27.00

Service Code	NDC 00143950801
Hospital Revenue Code	250
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: MDX Hawaii PPO	$26.19

KETOCONAZOLE 2 % SHAMPOO [14132]

Facility

IP

$106.00

Service Code	NDC 45802046564
Hospital Revenue Code	250
Min. Negotiated Rate	$90.10
Max. Negotiated Rate	$102.82
Rate for Payer: Cash Price	$63.60
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: MDX Hawaii PPO	$102.82

KETOCONAZOLE 2 % SHAMPOO [14132]

Facility

OP

$106.00

Service Code	NDC 45802046564
Hospital Revenue Code	637
Min. Negotiated Rate	$54.06
Max. Negotiated Rate	$102.82
Rate for Payer: Cash Price	$63.60
Rate for Payer: Hawaii Western Management Group Commercial	$100.70
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Kaiser Permanente Commercial	$66.78
Rate for Payer: Kaiser Permanente Medicaid	$54.06
Rate for Payer: MDX Hawaii PPO	$102.82
Rate for Payer: University Health Alliance Commercial	$77.26

KETOROLAC 0.5 % EYE DROPS [19733]

Facility

IP

$525.00

Service Code	NDC 61314012610
Hospital Revenue Code	250
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$509.25
Rate for Payer: Cash Price	$315.00
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: MDX Hawaii PPO	$509.25

KETOROLAC 0.5 % EYE DROPS [19733]

Facility

OP

$264.00

Service Code	NDC 61314012605
Hospital Revenue Code	637
Min. Negotiated Rate	$134.64
Max. Negotiated Rate	$256.08
Rate for Payer: Cash Price	$158.40
Rate for Payer: Hawaii Western Management Group Commercial	$250.80
Rate for Payer: Health Management Network Commercial	$224.40
Rate for Payer: Kaiser Permanente Commercial	$166.32
Rate for Payer: Kaiser Permanente Medicaid	$134.64
Rate for Payer: MDX Hawaii PPO	$256.08
Rate for Payer: University Health Alliance Commercial	$192.43

KETOROLAC 0.5 % EYE DROPS [19733]

Facility

OP

$268.00

Service Code	NDC 60505100301
Hospital Revenue Code	637
Min. Negotiated Rate	$136.68
Max. Negotiated Rate	$259.96
Rate for Payer: Cash Price	$160.80
Rate for Payer: Hawaii Western Management Group Commercial	$254.60
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: Kaiser Permanente Commercial	$168.84
Rate for Payer: Kaiser Permanente Medicaid	$136.68
Rate for Payer: MDX Hawaii PPO	$259.96
Rate for Payer: University Health Alliance Commercial	$195.35

KETOROLAC 0.5 % EYE DROPS [19733]

Facility

OP

$525.00

Service Code	NDC 61314012610
Hospital Revenue Code	637
Min. Negotiated Rate	$267.75
Max. Negotiated Rate	$509.25
Rate for Payer: Cash Price	$315.00
Rate for Payer: Hawaii Western Management Group Commercial	$498.75
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Kaiser Permanente Commercial	$330.75
Rate for Payer: Kaiser Permanente Medicaid	$267.75
Rate for Payer: MDX Hawaii PPO	$509.25
Rate for Payer: University Health Alliance Commercial	$382.67

KETOROLAC 0.5 % EYE DROPS [19733]

Facility

IP

$268.00

Service Code	NDC 60505100301
Hospital Revenue Code	250
Min. Negotiated Rate	$227.80
Max. Negotiated Rate	$259.96
Rate for Payer: Cash Price	$160.80
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: MDX Hawaii PPO	$259.96

KETOROLAC 0.5 % EYE DROPS [19733]

Facility

IP

$264.00

Service Code	NDC 61314012605
Hospital Revenue Code	250
Min. Negotiated Rate	$224.40
Max. Negotiated Rate	$256.08
Rate for Payer: Cash Price	$158.40
Rate for Payer: Health Management Network Commercial	$224.40
Rate for Payer: MDX Hawaii PPO	$256.08

KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]

Facility

IP

$21.00

Service Code	HCPCS J1885
Hospital Revenue Code	250
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: MDX Hawaii PPO	$20.37

KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION [22473]

Facility

OP

$8.00

Service Code	HCPCS J1885
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$0.39
Rate for Payer: AlohaCare Medicaid	$0.39
Rate for Payer: AlohaCare Medicaid	$0.39
Rate for Payer: AlohaCare Medicare	$0.39
Rate for Payer: AlohaCare Medicare	$0.39
Rate for Payer: AlohaCare Medicare	$0.39
Rate for Payer: Cash Price	$12.60
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cash Price	$12.60
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$0.43
Rate for Payer: Devoted Health Medicare	$0.43
Rate for Payer: Devoted Health Medicare	$0.43
Rate for Payer: Hawaii Medical Service Association ABD	$0.35
Rate for Payer: Hawaii Medical Service Association ABD	$0.35
Rate for Payer: Hawaii Medical Service Association ABD	$0.35
Rate for Payer: Hawaii Medical Service Association Commercial	$0.49
Rate for Payer: Hawaii Medical Service Association Commercial	$0.49
Rate for Payer: Hawaii Medical Service Association Commercial	$0.49
Rate for Payer: Hawaii Medical Service Association Medicare	$0.39
Rate for Payer: Hawaii Medical Service Association Medicare	$0.39
Rate for Payer: Hawaii Medical Service Association Medicare	$0.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.35
Rate for Payer: Hawaii Western Management Group Commercial	$19.95
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Humana Medicare	$0.39
Rate for Payer: Humana Medicare	$0.39
Rate for Payer: Humana Medicare	$0.39
Rate for Payer: Kaiser Permanente Commercial	$5.04
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Commercial	$13.23
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicare	$0.39
Rate for Payer: Kaiser Permanente Medicare	$0.39
Rate for Payer: Kaiser Permanente Medicare	$0.39
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: Ohana Health Plan Medicaid	$0.43
Rate for Payer: Ohana Health Plan Medicaid	$0.43
Rate for Payer: Ohana Health Plan Medicaid	$0.43
Rate for Payer: Ohana Health Plan Medicare	$0.39
Rate for Payer: Ohana Health Plan Medicare	$0.39
Rate for Payer: Ohana Health Plan Medicare	$0.39
Rate for Payer: UnitedHealthcare Medicaid	$9.00
Rate for Payer: UnitedHealthcare Medicaid	$4.80
Rate for Payer: UnitedHealthcare Medicaid	$12.60
Rate for Payer: UnitedHealthcare Medicare	$0.39
Rate for Payer: UnitedHealthcare Medicare	$0.39
Rate for Payer: UnitedHealthcare Medicare	$0.39
Rate for Payer: University Health Alliance Commercial	$5.83
Rate for Payer: University Health Alliance Commercial	$15.31
Rate for Payer: University Health Alliance Commercial	$10.93

KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION [97716]

Facility

OP

$9.00

Service Code	HCPCS J1885
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$8.73
Rate for Payer: AlohaCare Medicaid	$0.39
Rate for Payer: AlohaCare Medicaid	$0.39
Rate for Payer: AlohaCare Medicare	$0.39
Rate for Payer: AlohaCare Medicare	$0.39
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$0.43
Rate for Payer: Devoted Health Medicare	$0.43
Rate for Payer: Hawaii Medical Service Association ABD	$0.35
Rate for Payer: Hawaii Medical Service Association ABD	$0.35
Rate for Payer: Hawaii Medical Service Association Commercial	$0.49
Rate for Payer: Hawaii Medical Service Association Commercial	$0.49
Rate for Payer: Hawaii Medical Service Association Medicare	$0.39
Rate for Payer: Hawaii Medical Service Association Medicare	$0.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.35
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$0.39
Rate for Payer: Humana Medicare	$0.39
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Commercial	$5.67
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$0.39
Rate for Payer: Kaiser Permanente Medicare	$0.39
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$0.43
Rate for Payer: Ohana Health Plan Medicaid	$0.43
Rate for Payer: Ohana Health Plan Medicare	$0.39
Rate for Payer: Ohana Health Plan Medicare	$0.39
Rate for Payer: UnitedHealthcare Medicaid	$5.40
Rate for Payer: UnitedHealthcare Medicaid	$2.40
Rate for Payer: UnitedHealthcare Medicare	$0.39
Rate for Payer: UnitedHealthcare Medicare	$0.39
Rate for Payer: University Health Alliance Commercial	$6.56
Rate for Payer: University Health Alliance Commercial	$2.92

KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION [97716]

Facility

IP

$4.00

Service Code	HCPCS J1885
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: MDX Hawaii PPO	$8.73

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC

Facility

IP

$44,309.72

Service Code	MSDRG 657
Min. Negotiated Rate	$20,814.89
Max. Negotiated Rate	$44,309.72
Rate for Payer: AlohaCare Medicare	$20,814.89
Rate for Payer: Devoted Health Medicare	$22,896.38
Rate for Payer: Hawaii Medical Service Association Commercial	$44,309.72
Rate for Payer: Hawaii Medical Service Association Medicare	$20,814.89
Rate for Payer: Humana Medicare	$20,814.89
Rate for Payer: Kaiser Permanente Commercial	$31,567.50
Rate for Payer: Kaiser Permanente Medicare	$20,814.89
Rate for Payer: Ohana Health Plan Medicare	$20,814.89
Rate for Payer: UnitedHealthcare Medicare	$20,814.89

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC

Facility

IP

$54,920.55

Service Code	MSDRG 656
Min. Negotiated Rate	$36,213.36
Max. Negotiated Rate	$54,920.55
Rate for Payer: AlohaCare Medicare	$36,213.36
Rate for Payer: Devoted Health Medicare	$39,834.70
Rate for Payer: Hawaii Medical Service Association Commercial	$44,309.72
Rate for Payer: Hawaii Medical Service Association Medicare	$36,213.36
Rate for Payer: Humana Medicare	$36,213.36
Rate for Payer: Kaiser Permanente Commercial	$54,920.55
Rate for Payer: Kaiser Permanente Medicare	$36,213.36
Rate for Payer: Ohana Health Plan Medicare	$36,213.36
Rate for Payer: UnitedHealthcare Medicare	$36,213.36

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC

Facility

IP

$44,309.72

Service Code	MSDRG 658
Min. Negotiated Rate	$17,650.56
Max. Negotiated Rate	$44,309.72
Rate for Payer: AlohaCare Medicare	$17,650.56
Rate for Payer: Devoted Health Medicare	$19,415.62
Rate for Payer: Hawaii Medical Service Association Commercial	$44,309.72
Rate for Payer: Hawaii Medical Service Association Medicare	$17,650.56
Rate for Payer: Humana Medicare	$17,650.56
Rate for Payer: Kaiser Permanente Commercial	$26,768.55
Rate for Payer: Kaiser Permanente Medicare	$17,650.56
Rate for Payer: Ohana Health Plan Medicare	$17,650.56
Rate for Payer: UnitedHealthcare Medicare	$17,650.56

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC

Facility

IP

$47,148.84

Service Code	MSDRG 660
Min. Negotiated Rate	$15,033.36
Max. Negotiated Rate	$47,148.84
Rate for Payer: AlohaCare Medicare	$15,033.36
Rate for Payer: Devoted Health Medicare	$16,536.70
Rate for Payer: Hawaii Medical Service Association Commercial	$47,148.84
Rate for Payer: Hawaii Medical Service Association Medicare	$15,033.36
Rate for Payer: Humana Medicare	$15,033.36
Rate for Payer: Kaiser Permanente Commercial	$22,799.33
Rate for Payer: Kaiser Permanente Medicare	$15,033.36
Rate for Payer: Ohana Health Plan Medicare	$15,033.36
Rate for Payer: UnitedHealthcare Medicare	$15,033.36

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC

Facility

IP

$48,895.99

Service Code	MSDRG 659
Min. Negotiated Rate	$28,900.84
Max. Negotiated Rate	$48,895.99
Rate for Payer: AlohaCare Medicare	$28,900.84
Rate for Payer: Devoted Health Medicare	$31,790.92
Rate for Payer: Hawaii Medical Service Association Commercial	$48,895.99
Rate for Payer: Hawaii Medical Service Association Medicare	$28,900.84
Rate for Payer: Humana Medicare	$28,900.84
Rate for Payer: Kaiser Permanente Commercial	$43,830.53
Rate for Payer: Kaiser Permanente Medicare	$28,900.84
Rate for Payer: Ohana Health Plan Medicare	$28,900.84
Rate for Payer: UnitedHealthcare Medicare	$28,900.84

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC

Facility

IP

$31,885.52

Service Code	MSDRG 661
Min. Negotiated Rate	$11,776.90
Max. Negotiated Rate	$31,885.52
Rate for Payer: AlohaCare Medicare	$11,776.90
Rate for Payer: Devoted Health Medicare	$12,954.59
Rate for Payer: Hawaii Medical Service Association Commercial	$31,885.52
Rate for Payer: Hawaii Medical Service Association Medicare	$11,776.90
Rate for Payer: Humana Medicare	$11,776.90
Rate for Payer: Kaiser Permanente Commercial	$17,860.65
Rate for Payer: Kaiser Permanente Medicare	$11,776.90
Rate for Payer: Ohana Health Plan Medicare	$11,776.90
Rate for Payer: UnitedHealthcare Medicare	$11,776.90

KIDNEY AND URINARY TRACT INFECTIONS WITH MCC

Facility

IP

$20,015.17

Service Code	MSDRG 689
Min. Negotiated Rate	$13,197.56
Max. Negotiated Rate	$20,015.17
Rate for Payer: AlohaCare Medicare	$13,197.56
Rate for Payer: Devoted Health Medicare	$14,517.32
Rate for Payer: Hawaii Medical Service Association Commercial	$17,956.84
Rate for Payer: Hawaii Medical Service Association Medicare	$13,197.56
Rate for Payer: Humana Medicare	$13,197.56
Rate for Payer: Kaiser Permanente Commercial	$20,015.17
Rate for Payer: Kaiser Permanente Medicare	$13,197.56
Rate for Payer: Ohana Health Plan Medicare	$13,197.56
Rate for Payer: UnitedHealthcare Medicare	$13,197.56

KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC

Facility

IP

$15,336.11

Service Code	MSDRG 690
Min. Negotiated Rate	$9,207.45
Max. Negotiated Rate	$15,336.11
Rate for Payer: AlohaCare Medicare	$9,207.45
Rate for Payer: Devoted Health Medicare	$10,128.19
Rate for Payer: Hawaii Medical Service Association Commercial	$15,336.11
Rate for Payer: Hawaii Medical Service Association Medicare	$9,207.45
Rate for Payer: Humana Medicare	$9,207.45
Rate for Payer: Kaiser Permanente Commercial	$13,963.88
Rate for Payer: Kaiser Permanente Medicare	$9,207.45
Rate for Payer: Ohana Health Plan Medicare	$9,207.45
Rate for Payer: UnitedHealthcare Medicare	$9,207.45

KIDNEY AND URINARY TRACT NEOPLASMS WITH CC

Facility

IP

$31,667.13

Service Code	MSDRG 687
Min. Negotiated Rate	$11,917.93
Max. Negotiated Rate	$31,667.13
Rate for Payer: AlohaCare Medicare	$11,917.93
Rate for Payer: Devoted Health Medicare	$13,109.72
Rate for Payer: Hawaii Medical Service Association Commercial	$31,667.13
Rate for Payer: Hawaii Medical Service Association Medicare	$11,917.93
Rate for Payer: Humana Medicare	$11,917.93
Rate for Payer: Kaiser Permanente Commercial	$18,074.55
Rate for Payer: Kaiser Permanente Medicare	$11,917.93
Rate for Payer: Ohana Health Plan Medicare	$11,917.93
Rate for Payer: UnitedHealthcare Medicare	$11,917.93

KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC

Facility

IP

$31,667.13

Service Code	MSDRG 686
Min. Negotiated Rate	$20,515.75
Max. Negotiated Rate	$31,667.13
Rate for Payer: AlohaCare Medicare	$20,515.75
Rate for Payer: Devoted Health Medicare	$22,567.33
Rate for Payer: Hawaii Medical Service Association Commercial	$31,667.13
Rate for Payer: Hawaii Medical Service Association Medicare	$20,515.75
Rate for Payer: Humana Medicare	$20,515.75
Rate for Payer: Kaiser Permanente Commercial	$31,113.83
Rate for Payer: Kaiser Permanente Medicare	$20,515.75
Rate for Payer: Ohana Health Plan Medicare	$20,515.75
Rate for Payer: UnitedHealthcare Medicare	$20,515.75

KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC

Facility

IP

$31,667.13

Service Code	MSDRG 688
Min. Negotiated Rate	$8,989.08
Max. Negotiated Rate	$31,667.13
Rate for Payer: AlohaCare Medicare	$8,989.08
Rate for Payer: Devoted Health Medicare	$9,887.99
Rate for Payer: Hawaii Medical Service Association Commercial	$31,667.13
Rate for Payer: Hawaii Medical Service Association Medicare	$8,989.08
Rate for Payer: Humana Medicare	$8,989.08
Rate for Payer: Kaiser Permanente Commercial	$13,632.67
Rate for Payer: Kaiser Permanente Medicare	$8,989.08
Rate for Payer: Ohana Health Plan Medicare	$8,989.08
Rate for Payer: UnitedHealthcare Medicare	$8,989.08

KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC

Facility

IP

$21,014.36

Service Code	MSDRG 695
Min. Negotiated Rate	$13,009.88
Max. Negotiated Rate	$21,014.36
Rate for Payer: AlohaCare Medicare	$13,009.88
Rate for Payer: Devoted Health Medicare	$14,310.87
Rate for Payer: Hawaii Medical Service Association Commercial	$21,014.36
Rate for Payer: Hawaii Medical Service Association Medicare	$13,009.88
Rate for Payer: Humana Medicare	$13,009.88
Rate for Payer: Kaiser Permanente Commercial	$19,730.55
Rate for Payer: Kaiser Permanente Medicare	$13,009.88
Rate for Payer: Ohana Health Plan Medicare	$13,009.88
Rate for Payer: UnitedHealthcare Medicare	$13,009.88

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