Kau Hospital

All Charges

Charge

Type

Setting

Price

KETAMINE 100 MG/ML INJECTION SOLUTION [4237]

Facility

$54.00

Service Code	NDC 00143950901
Hospital Revenue Code	250
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$32.40
Rate for Payer: Health Management Network Commercial	$45.90
Rate for Payer: Kaiser Permanente Commercial	$48.60
Rate for Payer: MDX Hawaii PPO	$52.38

KETAMINE 100 MG/ML INJECTION SOLUTION [4237]

Facility

$54.00

Service Code	NDC 00143950910
Hospital Revenue Code	250
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$52.38
Rate for Payer: Cash Price	$32.40
Rate for Payer: Health Management Network Commercial	$45.90
Rate for Payer: Kaiser Permanente Commercial	$48.60
Rate for Payer: MDX Hawaii PPO	$52.38

KETAMINE 100 MG/ML INJECTION SOLUTION [4237]

Facility

$35.00

Service Code	NDC 00409205105
Hospital Revenue Code	250
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$33.95
Rate for Payer: Cash Price	$21.00
Rate for Payer: Health Management Network Commercial	$29.75
Rate for Payer: Kaiser Permanente Commercial	$31.50
Rate for Payer: MDX Hawaii PPO	$33.95

KETAMINE 10 MG/ML INJECTION SOLUTION [4236]

Facility

$84.00

Service Code	NDC 42023011310
Hospital Revenue Code	250
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: MDX Hawaii PPO	$81.48

KETAMINE 50 MG/5 ML (10 MG/ML) IN SODIUM CHLOR,ISO-OSMOTIC INJ SYRINGE [162740]

Facility

$25.00

Service Code	NDC 71266908002
Hospital Revenue Code	250
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$15.00
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: MDX Hawaii PPO	$24.25

KETAMINE 50 MG/5 ML (10 MG/ML) IN SODIUM CHLOR,ISO-OSMOTIC INJ SYRINGE [162740]

Facility

$25.00

Service Code	NDC 71266908004
Hospital Revenue Code	250
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$15.00
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: MDX Hawaii PPO	$24.25

KETAMINE 50 MG/ML INJECTION SOLUTION [4238]

Facility

$27.00

Service Code	NDC 00143950810
Hospital Revenue Code	250
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cash Price	$32.40
Rate for Payer: Health Management Network Commercial	$45.90
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Kaiser Permanente Commercial	$24.30
Rate for Payer: Kaiser Permanente Commercial	$48.60
Rate for Payer: MDX Hawaii PPO	$26.19
Rate for Payer: MDX Hawaii PPO	$52.38

KETAMINE 50 MG/ML INJECTION SOLUTION [4238]

Facility

$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: Kaiser Permanente Commercial	$24.30
Rate for Payer: MDX Hawaii PPO	$26.19

KETOCONAZOLE 2 % SHAMPOO [14132]

Facility

$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: Kaiser Permanente Commercial	$95.40
Rate for Payer: MDX Hawaii PPO	$102.82

KETOCONAZOLE 2 % SHAMPOO [14132]

Facility

$106.00

Service Code	NDC 45802046564
Hospital Revenue Code	637
Min. Negotiated Rate	$32.86
Max. Negotiated Rate	$102.82
Rate for Payer: AlohaCare Medicaid	$53.00
Rate for Payer: AlohaCare Medicare	$32.86
Rate for Payer: Cash Price	$63.60
Rate for Payer: Devoted Health Medicare	$36.04
Rate for Payer: Hawaii Medical Service Association Medicare	$32.86
Rate for Payer: Hawaii Western Management Group Commercial	$100.70
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Humana Medicare	$32.86
Rate for Payer: Kaiser Permanente Commercial	$95.40
Rate for Payer: Kaiser Permanente Medicaid	$54.06
Rate for Payer: Kaiser Permanente Medicare	$32.86
Rate for Payer: MDX Hawaii PPO	$102.82
Rate for Payer: Ohana Health Plan Medicaid	$32.86
Rate for Payer: Ohana Health Plan Medicare	$32.86
Rate for Payer: UnitedHealthcare Medicare	$32.86
Rate for Payer: University Health Alliance Commercial	$77.26

KETOROLAC 0.5 % EYE DROPS [19733]

Facility

$525.00

Service Code	NDC 61314012610
Hospital Revenue Code	637
Min. Negotiated Rate	$162.75
Max. Negotiated Rate	$509.25
Rate for Payer: AlohaCare Medicaid	$262.50
Rate for Payer: AlohaCare Medicare	$162.75
Rate for Payer: Cash Price	$315.00
Rate for Payer: Devoted Health Medicare	$178.50
Rate for Payer: Hawaii Medical Service Association Medicare	$162.75
Rate for Payer: Hawaii Western Management Group Commercial	$498.75
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Humana Medicare	$162.75
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: Kaiser Permanente Medicaid	$267.75
Rate for Payer: Kaiser Permanente Medicare	$162.75
Rate for Payer: MDX Hawaii PPO	$509.25
Rate for Payer: Ohana Health Plan Medicaid	$162.75
Rate for Payer: Ohana Health Plan Medicare	$162.75
Rate for Payer: UnitedHealthcare Medicare	$162.75
Rate for Payer: University Health Alliance Commercial	$382.67

KETOROLAC 0.5 % EYE DROPS [19733]

Facility

$264.00

Service Code	NDC 61314012605
Hospital Revenue Code	637
Min. Negotiated Rate	$81.84
Max. Negotiated Rate	$256.08
Rate for Payer: AlohaCare Medicaid	$132.00
Rate for Payer: AlohaCare Medicare	$81.84
Rate for Payer: Cash Price	$158.40
Rate for Payer: Devoted Health Medicare	$89.76
Rate for Payer: Hawaii Medical Service Association Medicare	$81.84
Rate for Payer: Hawaii Western Management Group Commercial	$250.80
Rate for Payer: Health Management Network Commercial	$224.40
Rate for Payer: Humana Medicare	$81.84
Rate for Payer: Kaiser Permanente Commercial	$237.60
Rate for Payer: Kaiser Permanente Medicaid	$134.64
Rate for Payer: Kaiser Permanente Medicare	$81.84
Rate for Payer: MDX Hawaii PPO	$256.08
Rate for Payer: Ohana Health Plan Medicaid	$81.84
Rate for Payer: Ohana Health Plan Medicare	$81.84
Rate for Payer: UnitedHealthcare Medicare	$81.84
Rate for Payer: University Health Alliance Commercial	$192.43

KETOROLAC 0.5 % EYE DROPS [19733]

Facility

$268.00

Service Code	NDC 60505100301
Hospital Revenue Code	637
Min. Negotiated Rate	$83.08
Max. Negotiated Rate	$259.96
Rate for Payer: AlohaCare Medicaid	$134.00
Rate for Payer: AlohaCare Medicare	$83.08
Rate for Payer: Cash Price	$160.80
Rate for Payer: Devoted Health Medicare	$91.12
Rate for Payer: Hawaii Medical Service Association Medicare	$83.08
Rate for Payer: Hawaii Western Management Group Commercial	$254.60
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: Humana Medicare	$83.08
Rate for Payer: Kaiser Permanente Commercial	$241.20
Rate for Payer: Kaiser Permanente Medicaid	$136.68
Rate for Payer: Kaiser Permanente Medicare	$83.08
Rate for Payer: MDX Hawaii PPO	$259.96
Rate for Payer: Ohana Health Plan Medicaid	$83.08
Rate for Payer: Ohana Health Plan Medicare	$83.08
Rate for Payer: UnitedHealthcare Medicare	$83.08
Rate for Payer: University Health Alliance Commercial	$195.35

KETOROLAC 0.5 % EYE DROPS [19733]

Facility

$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: Kaiser Permanente Commercial	$472.50
Rate for Payer: MDX Hawaii PPO	$509.25

KETOROLAC 0.5 % EYE DROPS [19733]

Facility

$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: Kaiser Permanente Commercial	$237.60
Rate for Payer: MDX Hawaii PPO	$256.08

KETOROLAC 0.5 % EYE DROPS [19733]

Facility

$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: Kaiser Permanente Commercial	$241.20
Rate for Payer: MDX Hawaii PPO	$259.96

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

Facility

$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: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: MDX Hawaii PPO	$14.55

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

Facility

$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	$4.00
Rate for Payer: AlohaCare Medicaid	$10.50
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$4.65
Rate for Payer: AlohaCare Medicare	$6.51
Rate for Payer: AlohaCare Medicare	$2.48
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: Cash Price	$12.60
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$7.14
Rate for Payer: Devoted Health Medicare	$2.72
Rate for Payer: Devoted Health Medicare	$5.10
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	$0.43
Rate for Payer: Hawaii Medical Service Association Commercial	$0.43
Rate for Payer: Hawaii Medical Service Association Commercial	$0.43
Rate for Payer: Hawaii Medical Service Association Medicare	$6.51
Rate for Payer: Hawaii Medical Service Association Medicare	$4.65
Rate for Payer: Hawaii Medical Service Association Medicare	$2.48
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	$14.25
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
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	$6.51
Rate for Payer: Humana Medicare	$2.48
Rate for Payer: Humana Medicare	$4.65
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$4.65
Rate for Payer: Kaiser Permanente Medicare	$6.51
Rate for Payer: Kaiser Permanente Medicare	$2.48
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	$6.51
Rate for Payer: Ohana Health Plan Medicaid	$2.48
Rate for Payer: Ohana Health Plan Medicaid	$4.65
Rate for Payer: Ohana Health Plan Medicare	$2.48
Rate for Payer: Ohana Health Plan Medicare	$6.51
Rate for Payer: Ohana Health Plan Medicare	$4.65
Rate for Payer: UnitedHealthcare Medicaid	$9.00
Rate for Payer: UnitedHealthcare Medicaid	$12.60
Rate for Payer: UnitedHealthcare Medicaid	$4.80
Rate for Payer: UnitedHealthcare Medicare	$4.65
Rate for Payer: UnitedHealthcare Medicare	$6.51
Rate for Payer: UnitedHealthcare Medicare	$2.48
Rate for Payer: University Health Alliance Commercial	$5.83
Rate for Payer: University Health Alliance Commercial	$10.93
Rate for Payer: University Health Alliance Commercial	$15.31

KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION [97716]

Facility

$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: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: MDX Hawaii PPO	$3.88

KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION [97716]

Facility

$4.00

Service Code	HCPCS J1885
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$2.79
Rate for Payer: AlohaCare Medicare	$1.24
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$1.36
Rate for Payer: Devoted Health Medicare	$3.06
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	$0.43
Rate for Payer: Hawaii Medical Service Association Commercial	$0.43
Rate for Payer: Hawaii Medical Service Association Medicare	$2.79
Rate for Payer: Hawaii Medical Service Association Medicare	$1.24
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	$7.65
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$1.24
Rate for Payer: Humana Medicare	$2.79
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$1.24
Rate for Payer: Kaiser Permanente Medicare	$2.79
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$2.79
Rate for Payer: Ohana Health Plan Medicaid	$1.24
Rate for Payer: Ohana Health Plan Medicare	$1.24
Rate for Payer: Ohana Health Plan Medicare	$2.79
Rate for Payer: UnitedHealthcare Medicaid	$5.40
Rate for Payer: UnitedHealthcare Medicaid	$2.40
Rate for Payer: UnitedHealthcare Medicare	$1.24
Rate for Payer: UnitedHealthcare Medicare	$2.79
Rate for Payer: University Health Alliance Commercial	$2.92
Rate for Payer: University Health Alliance Commercial	$6.56

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC

Facility

$43,279.85

Service Code	MSDRG 657
Min. Negotiated Rate	$43,279.85
Max. Negotiated Rate	$43,279.85
Rate for Payer: Hawaii Medical Service Association Commercial	$43,279.85

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC

Facility

$43,279.85

Service Code	MSDRG 656
Min. Negotiated Rate	$43,279.85
Max. Negotiated Rate	$43,279.85
Rate for Payer: Hawaii Medical Service Association Commercial	$43,279.85

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC

Facility

$43,279.85

Service Code	MSDRG 658
Min. Negotiated Rate	$43,279.85
Max. Negotiated Rate	$43,279.85
Rate for Payer: Hawaii Medical Service Association Commercial	$43,279.85

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC

Facility

$46,052.99

Service Code	MSDRG 660
Min. Negotiated Rate	$46,052.99
Max. Negotiated Rate	$46,052.99
Rate for Payer: Hawaii Medical Service Association Commercial	$46,052.99

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC

Facility

$47,759.53

Service Code	MSDRG 659
Min. Negotiated Rate	$47,759.53
Max. Negotiated Rate	$47,759.53
Rate for Payer: Hawaii Medical Service Association Commercial	$47,759.53

Know your out-of-pocket cost for care.

All Charges