Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

KETOCONAZOLE 2 % TOPICAL CREAM [10368]

Facility

IP

$1.52

Service Code	NDC 51672-1298-2
Hospital Charge Code	1743493
Hospital Revenue Code	259
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.22
Rate for Payer: Cash Price	$0.68
Rate for Payer: Cigna of CA HMO/PPO	$1.22
Rate for Payer: Health Smart Auto/Commercial	$0.91
Rate for Payer: LLUH Dept of Risk Management WC	$0.84
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.14

KETOCONAZOLE 2 % TOPICAL CREAM [10368]

Facility

OP

$1.67

Service Code	NDC 0093-3219-30
Hospital Charge Code	1743493
Hospital Revenue Code	259
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.25
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.00
Rate for Payer: Aetna of CA Government/Medicare	$1.00
Rate for Payer: Cash Price	$0.75
Rate for Payer: Health Smart Auto/Commercial	$1.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.00
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.25

KETOCONAZOLE 2 % TOPICAL CREAM [10368]

Facility

IP

$1.67

Service Code	NDC 0093-3219-30
Hospital Charge Code	1743493
Hospital Revenue Code	259
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.34
Rate for Payer: Cash Price	$0.75
Rate for Payer: Cigna of CA HMO/PPO	$1.34
Rate for Payer: Health Smart Auto/Commercial	$1.00
Rate for Payer: LLUH Dept of Risk Management WC	$0.92
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.25

KETOCONAZOLE ORAL SUSPENSION COMPOUND 20 MG/ML [4080285]

Facility

IP

$0.31

Service Code	NDC 9994-0802-85
Hospital Charge Code	1715910
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.25
Rate for Payer: Cash Price	$0.14
Rate for Payer: Cigna of CA HMO/PPO	$0.25
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

KETOCONAZOLE ORAL SUSPENSION COMPOUND 20 MG/ML [4080285]

Facility

OP

$0.31

Service Code	NDC 9994-0802-85
Hospital Charge Code	1715910
Hospital Revenue Code	259
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.19
Rate for Payer: Aetna of CA Government/Medicare	$0.19
Rate for Payer: Cash Price	$0.14
Rate for Payer: Health Smart Auto/Commercial	$0.19
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.17
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.23

KETOROLAC 0.5 % EYE DROPS [19733]

Facility

IP

$7.69

Service Code	NDC 17478-209-10
Hospital Charge Code	1740309
Hospital Revenue Code	259
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$6.15
Rate for Payer: Cash Price	$3.46
Rate for Payer: Cigna of CA HMO/PPO	$6.15
Rate for Payer: Health Smart Auto/Commercial	$4.61
Rate for Payer: LLUH Dept of Risk Management WC	$4.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.77

KETOROLAC 0.5 % EYE DROPS [19733]

Facility

IP

$7.69

Service Code	NDC 60505-1003-1
Hospital Charge Code	1740309
Hospital Revenue Code	259
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$6.15
Rate for Payer: Cash Price	$3.46
Rate for Payer: Cigna of CA HMO/PPO	$6.15
Rate for Payer: Health Smart Auto/Commercial	$4.61
Rate for Payer: LLUH Dept of Risk Management WC	$4.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.77

KETOROLAC 0.5 % EYE DROPS [19733]

Facility

OP

$6.72

Service Code	NDC 61314-126-05
Hospital Charge Code	1740309
Hospital Revenue Code	259
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$5.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.03
Rate for Payer: Aetna of CA Government/Medicare	$4.03
Rate for Payer: Cash Price	$3.02
Rate for Payer: Health Smart Auto/Commercial	$4.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.03
Rate for Payer: LLUH Dept of Risk Management WC	$3.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.04

KETOROLAC 0.5 % EYE DROPS [19733]

Facility

IP

$6.72

Service Code	NDC 61314-126-05
Hospital Charge Code	1740309
Hospital Revenue Code	259
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$5.38
Rate for Payer: Cash Price	$3.02
Rate for Payer: Cigna of CA HMO/PPO	$5.38
Rate for Payer: Health Smart Auto/Commercial	$4.03
Rate for Payer: LLUH Dept of Risk Management WC	$3.70
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.04

KETOROLAC 0.5 % EYE DROPS [19733]

Facility

OP

$7.69

Service Code	NDC 17478-209-10
Hospital Charge Code	1740309
Hospital Revenue Code	259
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$5.77
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.61
Rate for Payer: Aetna of CA Government/Medicare	$4.61
Rate for Payer: Cash Price	$3.46
Rate for Payer: Health Smart Auto/Commercial	$4.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.61
Rate for Payer: LLUH Dept of Risk Management WC	$4.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.77

KETOROLAC 0.5 % EYE DROPS [19733]

Facility

OP

$7.69

Service Code	NDC 60505-1003-1
Hospital Charge Code	1740309
Hospital Revenue Code	259
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$5.77
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.61
Rate for Payer: Aetna of CA Government/Medicare	$4.61
Rate for Payer: Cash Price	$3.46
Rate for Payer: Health Smart Auto/Commercial	$4.61
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.61
Rate for Payer: LLUH Dept of Risk Management WC	$4.23
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.77

KETOROLAC 10 MG TABLET [10371]

Facility

OP

$1.29

Service Code	NDC 0093-0314-01
Hospital Charge Code	1711527
Hospital Revenue Code	259
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$0.97
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.77
Rate for Payer: Aetna of CA Government/Medicare	$0.77
Rate for Payer: Cash Price	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.77
Rate for Payer: LLUH Dept of Risk Management WC	$0.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.97

KETOROLAC 10 MG TABLET [10371]

Facility

IP

$1.29

Service Code	NDC 69543-388-10
Hospital Charge Code	1711527
Hospital Revenue Code	259
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$1.03
Rate for Payer: Cash Price	$0.58
Rate for Payer: Cigna of CA HMO/PPO	$1.03
Rate for Payer: Health Smart Auto/Commercial	$0.77
Rate for Payer: LLUH Dept of Risk Management WC	$0.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.97

KETOROLAC 10 MG TABLET [10371]

Facility

IP

$1.29

Service Code	NDC 0093-0314-01
Hospital Charge Code	1711527
Hospital Revenue Code	259
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$1.03
Rate for Payer: Cash Price	$0.58
Rate for Payer: Cigna of CA HMO/PPO	$1.03
Rate for Payer: Health Smart Auto/Commercial	$0.77
Rate for Payer: LLUH Dept of Risk Management WC	$0.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.97

KETOROLAC 10 MG TABLET [10371]

Facility

OP

$1.29

Service Code	NDC 69543-388-10
Hospital Charge Code	1711527
Hospital Revenue Code	259
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$0.97
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.77
Rate for Payer: Aetna of CA Government/Medicare	$0.77
Rate for Payer: Cash Price	$0.58
Rate for Payer: Health Smart Auto/Commercial	$0.77
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.77
Rate for Payer: LLUH Dept of Risk Management WC	$0.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.97

KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]

Facility

IP

$1.26

Service Code	CPT J1885
Hospital Charge Code	1720710
Hospital Revenue Code	636
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.01
Rate for Payer: Cash Price	$0.57
Rate for Payer: Cash Price	$2.03
Rate for Payer: Cash Price	$0.68
Rate for Payer: Cash Price	$0.97
Rate for Payer: Cigna of CA HMO/PPO	$1.20
Rate for Payer: Cigna of CA HMO/PPO	$3.60
Rate for Payer: Cigna of CA HMO/PPO	$1.73
Rate for Payer: Cigna of CA HMO/PPO	$1.01
Rate for Payer: Health Smart Auto/Commercial	$2.70
Rate for Payer: Health Smart Auto/Commercial	$1.30
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: Health Smart Auto/Commercial	$0.90
Rate for Payer: LLUH Dept of Risk Management WC	$2.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: LLUH Dept of Risk Management WC	$1.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.95
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.12

KETOROLAC 15 MG/ML INJECTION SOLUTION [22472]

Facility

OP

$4.50

Service Code	CPT J1885
Hospital Charge Code	1720710
Hospital Revenue Code	636
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$2.70
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.76
Rate for Payer: Aetna of CA Government/Medicare	$0.90
Rate for Payer: Aetna of CA Government/Medicare	$1.30
Rate for Payer: Aetna of CA Government/Medicare	$0.76
Rate for Payer: Aetna of CA Government/Medicare	$2.70
Rate for Payer: Cash Price	$0.57
Rate for Payer: Cash Price	$0.97
Rate for Payer: Cash Price	$0.68
Rate for Payer: Cash Price	$2.03
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: Health Smart Auto/Commercial	$2.70
Rate for Payer: Health Smart Auto/Commercial	$0.90
Rate for Payer: Health Smart Auto/Commercial	$1.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$2.70
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.90
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.30
Rate for Payer: LLUH Dept of Risk Management WC	$1.19
Rate for Payer: LLUH Dept of Risk Management WC	$0.83
Rate for Payer: LLUH Dept of Risk Management WC	$2.48
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$3.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.95

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

Facility

IP

$1.90

Service Code	CPT J1885
Hospital Charge Code	1720673
Hospital Revenue Code	636
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.52
Rate for Payer: Cash Price	$0.86
Rate for Payer: Cash Price	$0.47
Rate for Payer: Cash Price	$3.42
Rate for Payer: Cash Price	$1.03
Rate for Payer: Cash Price	$0.60
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.80
Rate for Payer: Cigna of CA HMO/PPO	$1.07
Rate for Payer: Cigna of CA HMO/PPO	$0.83
Rate for Payer: Cigna of CA HMO/PPO	$1.82
Rate for Payer: Cigna of CA HMO/PPO	$6.09
Rate for Payer: Cigna of CA HMO/PPO	$1.52
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: Health Smart Auto/Commercial	$0.80
Rate for Payer: Health Smart Auto/Commercial	$1.37
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Health Smart Auto/Commercial	$1.14
Rate for Payer: Health Smart Auto/Commercial	$4.57
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: LLUH Dept of Risk Management WC	$0.74
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: LLUH Dept of Risk Management WC	$1.04
Rate for Payer: LLUH Dept of Risk Management WC	$4.19
Rate for Payer: LLUH Dept of Risk Management WC	$1.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.71

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

Facility

OP

$6.00

Service Code	CPT J1885
Hospital Charge Code	1720673
Hospital Revenue Code	636
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.14
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$4.57
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.62
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.80
Rate for Payer: Aetna of CA Government/Medicare	$0.62
Rate for Payer: Aetna of CA Government/Medicare	$4.57
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$1.37
Rate for Payer: Aetna of CA Government/Medicare	$0.80
Rate for Payer: Aetna of CA Government/Medicare	$1.14
Rate for Payer: Cash Price	$1.03
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cash Price	$0.60
Rate for Payer: Cash Price	$3.42
Rate for Payer: Cash Price	$0.47
Rate for Payer: Cash Price	$0.86
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Health Smart Auto/Commercial	$4.57
Rate for Payer: Health Smart Auto/Commercial	$1.37
Rate for Payer: Health Smart Auto/Commercial	$0.80
Rate for Payer: Health Smart Auto/Commercial	$1.14
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.80
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.14
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.37
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$4.57
Rate for Payer: LLUH Dept of Risk Management WC	$0.74
Rate for Payer: LLUH Dept of Risk Management WC	$1.04
Rate for Payer: LLUH Dept of Risk Management WC	$4.19
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: LLUH Dept of Risk Management WC	$1.25
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$5.71
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.00
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.42
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.78
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.71

KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION [91349]

Facility

OP

$1.20

Service Code	CPT J1885
Hospital Charge Code	1720672
Hospital Revenue Code	636
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.90
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.72
Rate for Payer: Aetna of CA Government/Medicare	$0.72
Rate for Payer: Cash Price	$0.54
Rate for Payer: Health Smart Auto/Commercial	$0.72
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$0.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.90

KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION [91349]

Facility

IP

$1.20

Service Code	CPT J1885
Hospital Charge Code	1720672
Hospital Revenue Code	636
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.96
Rate for Payer: Cash Price	$0.54
Rate for Payer: Cigna of CA HMO/PPO	$0.96
Rate for Payer: Health Smart Auto/Commercial	$0.72
Rate for Payer: LLUH Dept of Risk Management WC	$0.66
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.90

KETOTIFEN 0.025 % EYE DROPS [25471]

Facility

IP

$2.19

Service Code	NDC 17478-717-10
Hospital Charge Code	NDG25471
Hospital Revenue Code	259
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.75
Rate for Payer: Cash Price	$0.99
Rate for Payer: Cigna of CA HMO/PPO	$1.75
Rate for Payer: Health Smart Auto/Commercial	$1.31
Rate for Payer: LLUH Dept of Risk Management WC	$1.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.64

KETOTIFEN 0.025 % EYE DROPS [25471]

Facility

IP

$2.50

Service Code	NDC 0065-4011-05
Hospital Charge Code	NDG25471
Hospital Revenue Code	259
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$2.00
Rate for Payer: Cash Price	$1.13
Rate for Payer: Cigna of CA HMO/PPO	$2.00
Rate for Payer: Health Smart Auto/Commercial	$1.50
Rate for Payer: LLUH Dept of Risk Management WC	$1.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.88

KETOTIFEN 0.025 % EYE DROPS [25471]

Facility

OP

$2.50

Service Code	NDC 0065-4011-05
Hospital Charge Code	NDG25471
Hospital Revenue Code	259
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$1.88
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.50
Rate for Payer: Aetna of CA Government/Medicare	$1.50
Rate for Payer: Cash Price	$1.13
Rate for Payer: Health Smart Auto/Commercial	$1.50
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.50
Rate for Payer: LLUH Dept of Risk Management WC	$1.38
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.88

KETOTIFEN 0.025 % EYE DROPS [25471]

Facility

OP

$2.19

Service Code	NDC 17478-717-10
Hospital Charge Code	NDG25471
Hospital Revenue Code	259
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.31
Rate for Payer: Aetna of CA Government/Medicare	$1.31
Rate for Payer: Cash Price	$0.99
Rate for Payer: Health Smart Auto/Commercial	$1.31
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.31
Rate for Payer: LLUH Dept of Risk Management WC	$1.20
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.64

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