Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

VALACYCLOVIR TABLETS (VALTREX 1GM ) 1 GM (TAKE HOME) [4080400]

Facility

IP

$15.00

Service Code	NDC 00004080187
Hospital Revenue Code	253
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: MDX Hawaii PPO	$14.55

VALACYCLOVIR TABLETS (VALTREX 1GM ) 1 GM (TAKE HOME) [4080400]

Facility

OP

$15.00

Service Code	NDC 00004080187
Hospital Revenue Code	253
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: University Health Alliance Commercial	$10.93

VA LCP 2.7X3.5MM 02.118.210S

Facility

OP

$5,856.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,986.56
Max. Negotiated Rate	$5,680.32
Rate for Payer: Cash Price	$3,513.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,099.20
Rate for Payer: Health Management Network Commercial	$4,977.60
Rate for Payer: Kaiser Permanente Commercial	$3,689.28
Rate for Payer: Kaiser Permanente Medicaid	$2,986.56
Rate for Payer: MDX Hawaii PPO	$5,680.32
Rate for Payer: University Health Alliance Commercial	$3,279.36

VA LCP 2.7X3.5MM 02.118.210S

Facility

IP

$5,856.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,279.36
Max. Negotiated Rate	$5,680.32
Rate for Payer: Cash Price	$3,513.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,099.20
Rate for Payer: Health Management Network Commercial	$4,977.60
Rate for Payer: MDX Hawaii PPO	$5,680.32
Rate for Payer: University Health Alliance Commercial	$3,279.36

VALGANCICLOVIR 450 MG TABLET [30148]

Facility

IP

$48.00

Service Code	NDC 68084096525
Hospital Revenue Code	250
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: MDX Hawaii PPO	$46.56

VALGANCICLOVIR 450 MG TABLET [30148]

Facility

IP

$38.00

Service Code	NDC 68084096518
Hospital Revenue Code	250
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: MDX Hawaii PPO	$36.86

VALGANCICLOVIR 450 MG TABLET [30148]

Facility

OP

$129.00

Service Code	NDC 31722083260
Hospital Revenue Code	637
Min. Negotiated Rate	$65.79
Max. Negotiated Rate	$125.13
Rate for Payer: Cash Price	$77.40
Rate for Payer: Hawaii Western Management Group Commercial	$122.55
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Kaiser Permanente Commercial	$81.27
Rate for Payer: Kaiser Permanente Medicaid	$65.79
Rate for Payer: MDX Hawaii PPO	$125.13
Rate for Payer: University Health Alliance Commercial	$94.03

VALGANCICLOVIR 450 MG TABLET [30148]

Facility

OP

$38.00

Service Code	NDC 68084096518
Hospital Revenue Code	637
Min. Negotiated Rate	$19.38
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Hawaii Western Management Group Commercial	$36.10
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Kaiser Permanente Commercial	$23.94
Rate for Payer: Kaiser Permanente Medicaid	$19.38
Rate for Payer: MDX Hawaii PPO	$36.86
Rate for Payer: University Health Alliance Commercial	$27.70

VALGANCICLOVIR 450 MG TABLET [30148]

Facility

OP

$48.00

Service Code	NDC 68084096525
Hospital Revenue Code	637
Min. Negotiated Rate	$24.48
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Hawaii Western Management Group Commercial	$45.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$30.24
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: University Health Alliance Commercial	$34.99

VALGANCICLOVIR 450 MG TABLET [30148]

Facility

IP

$129.00

Service Code	NDC 31722083260
Hospital Revenue Code	250
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$125.13
Rate for Payer: Cash Price	$77.40
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: MDX Hawaii PPO	$125.13

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]

Facility

IP

$29.00

Service Code	NDC 63323049405
Hospital Revenue Code	250
Min. Negotiated Rate	$24.65
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$17.40
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: MDX Hawaii PPO	$28.13

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]

Facility

IP

$30.00

Service Code	NDC 00143978510
Hospital Revenue Code	250
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Health Management Network Commercial	$38.25
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: MDX Hawaii PPO	$43.65

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [20887]

Facility

IP

$30.00

Service Code	NDC 00143978501
Hospital Revenue Code	250
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: MDX Hawaii PPO	$29.10

VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [205333]

Facility

OP

$7.00

Service Code	NDC 00121467505
Hospital Revenue Code	637
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$4.41
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: University Health Alliance Commercial	$5.10

VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [205333]

Facility

OP

$7.00

Service Code	NDC 00121467500
Hospital Revenue Code	637
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$4.41
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: University Health Alliance Commercial	$5.10

VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [205333]

Facility

IP

$7.00

Service Code	NDC 00121467500
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: MDX Hawaii PPO	$6.79

VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION [205333]

Facility

IP

$7.00

Service Code	NDC 00121467505
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: MDX Hawaii PPO	$6.79

VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION [107838]

Facility

IP

$120.00

Service Code	NDC 00121067585
Hospital Revenue Code	250
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: MDX Hawaii PPO	$116.40

VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION [107838]

Facility

OP

$120.00

Service Code	NDC 00121067585
Hospital Revenue Code	637
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Hawaii Western Management Group Commercial	$114.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: Kaiser Permanente Medicaid	$61.20
Rate for Payer: MDX Hawaii PPO	$116.40
Rate for Payer: University Health Alliance Commercial	$87.47

VALSARTAN 160 MG TABLET [31210]

Facility

OP

$6.00

Service Code	NDC 60687063411
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$3.78
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: University Health Alliance Commercial	$4.37

VALSARTAN 160 MG TABLET [31210]

Facility

IP

$6.00

Service Code	NDC 60687063411
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: MDX Hawaii PPO	$5.82

VALSARTAN 160 MG TABLET [31210]

Facility

IP

$6.00

Service Code	NDC 60687063401
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: MDX Hawaii PPO	$5.82

VALSARTAN 160 MG TABLET [31210]

Facility

OP

$6.00

Service Code	NDC 60687063401
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$3.78
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: University Health Alliance Commercial	$4.37

VALSARTAN 40 MG TABLET [33541]

Facility

OP

$6.00

Service Code	NDC 55111073130
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$3.78
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: University Health Alliance Commercial	$4.37

VALSARTAN 40 MG TABLET [33541]

Facility

OP

$15.00

Service Code	NDC 31722015130
Hospital Revenue Code	637
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: University Health Alliance Commercial	$10.93