Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

KETAMINE 100 MG/ML INJ SOLN

Facility

IP

$49.82

Service Code	NDC 00409004005
Hospital Revenue Code	250
Min. Negotiated Rate	$42.35
Max. Negotiated Rate	$48.33
Rate for Payer: Cash Price	$32.38
Rate for Payer: Health Management Network Commercial	$42.35
Rate for Payer: MDX Hawaii PPO	$48.33

KETAMINE 50 MG/ML (1 ML) IV SYR

Facility

IP

$55.11

Service Code	NDC 70092912043
Hospital Revenue Code	250
Min. Negotiated Rate	$46.84
Max. Negotiated Rate	$53.46
Rate for Payer: Cash Price	$35.82
Rate for Payer: Health Management Network Commercial	$46.84
Rate for Payer: MDX Hawaii PPO	$53.46

KETAMINE 50 MG/ML (1 ML) IV SYR

Facility

OP

$55.11

Service Code	NDC 70092912043
Hospital Revenue Code	250
Min. Negotiated Rate	$28.11
Max. Negotiated Rate	$53.46
Rate for Payer: Cash Price	$35.82
Rate for Payer: Hawaii Western Management Group Commercial	$52.35
Rate for Payer: Health Management Network Commercial	$46.84
Rate for Payer: Kaiser Permanente Commercial	$34.72
Rate for Payer: Kaiser Permanente Medicaid	$28.11
Rate for Payer: MDX Hawaii PPO	$53.46
Rate for Payer: UnitedHealthcare Medicaid	$33.07
Rate for Payer: University Health Alliance Commercial	$40.17

KETAMINE 50 MG/ML (1 ML) IV SYR

Facility

IP

$27.60

Service Code	NDC 63037013725
Hospital Revenue Code	250
Min. Negotiated Rate	$23.46
Max. Negotiated Rate	$26.77
Rate for Payer: Cash Price	$17.94
Rate for Payer: Health Management Network Commercial	$23.46
Rate for Payer: MDX Hawaii PPO	$26.77

KETAMINE 50 MG/ML (1 ML) IV SYR

Facility

OP

$46.55

Service Code	NDC 70092112043
Hospital Revenue Code	250
Min. Negotiated Rate	$23.74
Max. Negotiated Rate	$45.15
Rate for Payer: Cash Price	$30.26
Rate for Payer: Hawaii Western Management Group Commercial	$44.22
Rate for Payer: Health Management Network Commercial	$39.57
Rate for Payer: Kaiser Permanente Commercial	$29.33
Rate for Payer: Kaiser Permanente Medicaid	$23.74
Rate for Payer: MDX Hawaii PPO	$45.15
Rate for Payer: UnitedHealthcare Medicaid	$27.93
Rate for Payer: University Health Alliance Commercial	$33.93

KETAMINE 50 MG/ML (1 ML) IV SYR

Facility

IP

$46.55

Service Code	NDC 70092112043
Hospital Revenue Code	250
Min. Negotiated Rate	$39.57
Max. Negotiated Rate	$45.15
Rate for Payer: Cash Price	$30.26
Rate for Payer: Health Management Network Commercial	$39.57
Rate for Payer: MDX Hawaii PPO	$45.15

KETAMINE 50 MG/ML (1 ML) IV SYR

Facility

OP

$27.60

Service Code	NDC 63037013725
Hospital Revenue Code	250
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$26.77
Rate for Payer: Cash Price	$17.94
Rate for Payer: Hawaii Western Management Group Commercial	$26.22
Rate for Payer: Health Management Network Commercial	$23.46
Rate for Payer: Kaiser Permanente Commercial	$17.39
Rate for Payer: Kaiser Permanente Medicaid	$14.08
Rate for Payer: MDX Hawaii PPO	$26.77
Rate for Payer: UnitedHealthcare Medicaid	$16.56
Rate for Payer: University Health Alliance Commercial	$20.12

KETAMINE 50 MG/ML INJ SOLN

Facility

IP

$40.56

Service Code	NDC 00143950810
Hospital Revenue Code	250
Min. Negotiated Rate	$34.48
Max. Negotiated Rate	$39.34
Rate for Payer: Cash Price	$26.36
Rate for Payer: Health Management Network Commercial	$34.48
Rate for Payer: MDX Hawaii PPO	$39.34

KETAMINE 50 MG/ML INJ SOLN

Facility

OP

$40.56

Service Code	NDC 00143950810
Hospital Revenue Code	250
Min. Negotiated Rate	$20.69
Max. Negotiated Rate	$39.34
Rate for Payer: Cash Price	$26.36
Rate for Payer: Hawaii Western Management Group Commercial	$38.53
Rate for Payer: Health Management Network Commercial	$34.48
Rate for Payer: Kaiser Permanente Commercial	$25.55
Rate for Payer: Kaiser Permanente Medicaid	$20.69
Rate for Payer: MDX Hawaii PPO	$39.34
Rate for Payer: UnitedHealthcare Medicaid	$24.34
Rate for Payer: University Health Alliance Commercial	$29.56

KETAMINE 50 MG/ML INJ SOLN

Facility

IP

$40.56

Service Code	NDC 00143950801
Hospital Revenue Code	250
Min. Negotiated Rate	$34.48
Max. Negotiated Rate	$39.34
Rate for Payer: Cash Price	$26.36
Rate for Payer: Health Management Network Commercial	$34.48
Rate for Payer: MDX Hawaii PPO	$39.34

KETAMINE 50 MG/ML INJ SOLN

Facility

OP

$40.56

Service Code	NDC 00143950801
Hospital Revenue Code	250
Min. Negotiated Rate	$20.69
Max. Negotiated Rate	$39.34
Rate for Payer: Cash Price	$26.36
Rate for Payer: Hawaii Western Management Group Commercial	$38.53
Rate for Payer: Health Management Network Commercial	$34.48
Rate for Payer: Kaiser Permanente Commercial	$25.55
Rate for Payer: Kaiser Permanente Medicaid	$20.69
Rate for Payer: MDX Hawaii PPO	$39.34
Rate for Payer: UnitedHealthcare Medicaid	$24.34
Rate for Payer: University Health Alliance Commercial	$29.56

KETOCONAZOLE 2 % TOP CR

Facility

OP

$279.70

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$142.65
Max. Negotiated Rate	$271.31
Rate for Payer: Cash Price	$181.80
Rate for Payer: Cash Price	$437.27
Rate for Payer: Hawaii Western Management Group Commercial	$265.71
Rate for Payer: Hawaii Western Management Group Commercial	$639.09
Rate for Payer: Health Management Network Commercial	$237.75
Rate for Payer: Health Management Network Commercial	$571.82
Rate for Payer: Kaiser Permanente Commercial	$176.21
Rate for Payer: Kaiser Permanente Commercial	$423.82
Rate for Payer: Kaiser Permanente Medicaid	$142.65
Rate for Payer: Kaiser Permanente Medicaid	$343.09
Rate for Payer: MDX Hawaii PPO	$271.31
Rate for Payer: MDX Hawaii PPO	$652.55
Rate for Payer: UnitedHealthcare Medicaid	$403.64
Rate for Payer: UnitedHealthcare Medicaid	$167.82
Rate for Payer: University Health Alliance Commercial	$203.87
Rate for Payer: University Health Alliance Commercial	$490.35

KETOCONAZOLE 2 % TOP CR

Facility

IP

$279.70

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$237.75
Max. Negotiated Rate	$271.31
Rate for Payer: Cash Price	$181.80
Rate for Payer: Cash Price	$437.27
Rate for Payer: Health Management Network Commercial	$571.82
Rate for Payer: Health Management Network Commercial	$237.75
Rate for Payer: MDX Hawaii PPO	$271.31
Rate for Payer: MDX Hawaii PPO	$652.55

KETOCONAZOLE 2 % TOP SHAMPOO

Facility

OP

$143.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$73.03
Max. Negotiated Rate	$138.90
Rate for Payer: Cash Price	$93.08
Rate for Payer: Hawaii Western Management Group Commercial	$136.04
Rate for Payer: Health Management Network Commercial	$121.72
Rate for Payer: Kaiser Permanente Commercial	$90.22
Rate for Payer: Kaiser Permanente Medicaid	$73.03
Rate for Payer: MDX Hawaii PPO	$138.90
Rate for Payer: UnitedHealthcare Medicaid	$85.92
Rate for Payer: University Health Alliance Commercial	$104.38

KETOCONAZOLE 2 % TOP SHAMPOO

Facility

IP

$143.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$121.72
Max. Negotiated Rate	$138.90
Rate for Payer: Cash Price	$93.08
Rate for Payer: Health Management Network Commercial	$121.72
Rate for Payer: MDX Hawaii PPO	$138.90

KETOROLAC 0.5 % OPHT DROP

Facility

IP

$459.02

Service Code	NDC 61314012605
Hospital Revenue Code	250
Min. Negotiated Rate	$390.17
Max. Negotiated Rate	$445.25
Rate for Payer: Cash Price	$298.36
Rate for Payer: Health Management Network Commercial	$390.17
Rate for Payer: MDX Hawaii PPO	$445.25

KETOROLAC 0.5 % OPHT DROP

Facility

OP

$461.87

Service Code	NDC 60505100301
Hospital Revenue Code	250
Min. Negotiated Rate	$235.55
Max. Negotiated Rate	$448.01
Rate for Payer: Cash Price	$300.22
Rate for Payer: Hawaii Western Management Group Commercial	$438.78
Rate for Payer: Health Management Network Commercial	$392.59
Rate for Payer: Kaiser Permanente Commercial	$290.98
Rate for Payer: Kaiser Permanente Medicaid	$235.55
Rate for Payer: MDX Hawaii PPO	$448.01
Rate for Payer: UnitedHealthcare Medicaid	$277.12
Rate for Payer: University Health Alliance Commercial	$336.66

KETOROLAC 0.5 % OPHT DROP

Facility

IP

$461.87

Service Code	NDC 60505100301
Hospital Revenue Code	250
Min. Negotiated Rate	$392.59
Max. Negotiated Rate	$448.01
Rate for Payer: Cash Price	$300.22
Rate for Payer: Health Management Network Commercial	$392.59
Rate for Payer: MDX Hawaii PPO	$448.01

KETOROLAC 0.5 % OPHT DROP

Facility

OP

$459.02

Service Code	NDC 61314012605
Hospital Revenue Code	250
Min. Negotiated Rate	$234.10
Max. Negotiated Rate	$445.25
Rate for Payer: Cash Price	$298.36
Rate for Payer: Hawaii Western Management Group Commercial	$436.07
Rate for Payer: Health Management Network Commercial	$390.17
Rate for Payer: Kaiser Permanente Commercial	$289.18
Rate for Payer: Kaiser Permanente Medicaid	$234.10
Rate for Payer: MDX Hawaii PPO	$445.25
Rate for Payer: UnitedHealthcare Medicaid	$275.41
Rate for Payer: University Health Alliance Commercial	$334.58

KETOROLAC 10 MG PO TABLET

Facility

IP

$11.91

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$11.55
Rate for Payer: Cash Price	$7.74
Rate for Payer: Health Management Network Commercial	$10.12
Rate for Payer: MDX Hawaii PPO	$11.55

KETOROLAC 10 MG PO TABLET

Facility

OP

$11.91

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.07
Max. Negotiated Rate	$11.55
Rate for Payer: Cash Price	$7.74
Rate for Payer: Hawaii Western Management Group Commercial	$11.31
Rate for Payer: Health Management Network Commercial	$10.12
Rate for Payer: Kaiser Permanente Commercial	$7.50
Rate for Payer: Kaiser Permanente Medicaid	$6.07
Rate for Payer: MDX Hawaii PPO	$11.55
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: University Health Alliance Commercial	$8.68

KETOROLAC 30 MG/ML (1 ML) INJ SOLN

Facility

IP

$27.55

Service Code	HCPCS J1885
Hospital Revenue Code	250
Min. Negotiated Rate	$23.42
Max. Negotiated Rate	$26.72
Rate for Payer: Cash Price	$17.91
Rate for Payer: Cash Price	$6.28
Rate for Payer: Health Management Network Commercial	$23.42
Rate for Payer: Health Management Network Commercial	$8.21
Rate for Payer: MDX Hawaii PPO	$26.72
Rate for Payer: MDX Hawaii PPO	$9.37

KETOROLAC 30 MG/ML (1 ML) INJ SOLN

Facility

OP

$27.55

Service Code	HCPCS J1885
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$26.72
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	$17.91
Rate for Payer: Cash Price	$6.28
Rate for Payer: Cash Price	$17.91
Rate for Payer: Cash Price	$6.28
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	$26.17
Rate for Payer: Hawaii Western Management Group Commercial	$9.18
Rate for Payer: Health Management Network Commercial	$8.21
Rate for Payer: Health Management Network Commercial	$23.42
Rate for Payer: Humana Medicare	$0.39
Rate for Payer: Humana Medicare	$0.39
Rate for Payer: Kaiser Permanente Commercial	$17.36
Rate for Payer: Kaiser Permanente Commercial	$6.09
Rate for Payer: Kaiser Permanente Medicaid	$14.05
Rate for Payer: Kaiser Permanente Medicaid	$4.93
Rate for Payer: Kaiser Permanente Medicare	$0.39
Rate for Payer: Kaiser Permanente Medicare	$0.39
Rate for Payer: MDX Hawaii PPO	$26.72
Rate for Payer: MDX Hawaii PPO	$9.37
Rate for Payer: Ohana Health Plan Medicaid	$0.43
Rate for Payer: Ohana Health Plan Medicaid	$0.43
Rate for Payer: Ohana Health Plan Medicare	$0.39
Rate for Payer: Ohana Health Plan Medicare	$0.39
Rate for Payer: UnitedHealthcare Medicaid	$16.53
Rate for Payer: UnitedHealthcare Medicaid	$5.80
Rate for Payer: UnitedHealthcare Medicare	$0.39
Rate for Payer: UnitedHealthcare Medicare	$0.39
Rate for Payer: University Health Alliance Commercial	$20.08
Rate for Payer: University Health Alliance Commercial	$7.04

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC

Facility

IP

$44,019.38

Service Code	MSDRG 657
Min. Negotiated Rate	$24,069.56
Max. Negotiated Rate	$44,019.38
Rate for Payer: AlohaCare Medicare	$24,069.56
Rate for Payer: Devoted Health Medicare	$26,476.52
Rate for Payer: Hawaii Medical Service Association Commercial	$44,019.38
Rate for Payer: Hawaii Medical Service Association Medicare	$24,069.56
Rate for Payer: Humana Medicare	$24,069.56
Rate for Payer: Kaiser Permanente Commercial	$31,567.50
Rate for Payer: Kaiser Permanente Medicare	$24,069.56
Rate for Payer: Ohana Health Plan Medicare	$24,069.56
Rate for Payer: UnitedHealthcare Medicare	$24,069.56

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC

Facility

IP

$54,920.55

Service Code	MSDRG 656
Min. Negotiated Rate	$41,875.78
Max. Negotiated Rate	$54,920.55
Rate for Payer: AlohaCare Medicare	$41,875.78
Rate for Payer: Devoted Health Medicare	$46,063.36
Rate for Payer: Hawaii Medical Service Association Commercial	$44,019.38
Rate for Payer: Hawaii Medical Service Association Medicare	$41,875.78
Rate for Payer: Humana Medicare	$41,875.78
Rate for Payer: Kaiser Permanente Commercial	$54,920.55
Rate for Payer: Kaiser Permanente Medicare	$41,875.78
Rate for Payer: Ohana Health Plan Medicare	$41,875.78
Rate for Payer: UnitedHealthcare Medicare	$41,875.78

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