Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC

Facility

IP

$26,451.43

Service Code	MSDRG 747
Min. Negotiated Rate	$26,451.43
Max. Negotiated Rate	$26,451.43
Rate for Payer: Hawaii Medical Service Association Commercial	$26,451.43

VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C

Facility

IP

$12,490.95

Service Code	MSDRG 768
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$12,490.95
Rate for Payer: Hawaii Medical Service Association Commercial	$12,490.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC

Facility

IP

$10,120.75

Service Code	MSDRG 806
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$10,120.75
Rate for Payer: Hawaii Medical Service Association Commercial	$10,120.75
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC

Facility

IP

$10,120.75

Service Code	MSDRG 805
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$10,120.75
Rate for Payer: Hawaii Medical Service Association Commercial	$10,120.75
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC

Facility

IP

$9,125.27

Service Code	MSDRG 807
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$9,125.27
Rate for Payer: Hawaii Medical Service Association Commercial	$9,125.27
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC

Facility

IP

$14,695.24

Service Code	MSDRG 797
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$14,695.24
Rate for Payer: Hawaii Medical Service Association Commercial	$14,695.24
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC

Facility

IP

$14,695.24

Service Code	MSDRG 796
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$14,695.24
Rate for Payer: Hawaii Medical Service Association Commercial	$14,695.24
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC

Facility

IP

$14,695.24

Service Code	MSDRG 798
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$14,695.24
Rate for Payer: Hawaii Medical Service Association Commercial	$14,695.24
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: University Health Alliance Commercial	$7,760.00

VALACYCLOVIR 1 GRAM TABLET [13132]

Facility

IP

$19.00

Service Code	NDC 68084030921
Hospital Revenue Code	250
Min. Negotiated Rate	$16.15
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$11.40
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Kaiser Permanente Commercial	$17.10
Rate for Payer: MDX Hawaii PPO	$18.43

VALACYCLOVIR 1 GRAM TABLET [13132]

Facility

OP

$19.00

Service Code	NDC 68084030911
Hospital Revenue Code	637
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$18.43
Rate for Payer: AlohaCare Medicaid	$9.50
Rate for Payer: AlohaCare Medicare	$5.89
Rate for Payer: Cash Price	$11.40
Rate for Payer: Devoted Health Medicare	$6.46
Rate for Payer: Hawaii Medical Service Association Medicare	$5.89
Rate for Payer: Hawaii Western Management Group Commercial	$18.05
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Humana Medicare	$5.89
Rate for Payer: Kaiser Permanente Commercial	$17.10
Rate for Payer: Kaiser Permanente Medicaid	$9.69
Rate for Payer: Kaiser Permanente Medicare	$5.89
Rate for Payer: MDX Hawaii PPO	$18.43
Rate for Payer: Ohana Health Plan Medicaid	$5.89
Rate for Payer: Ohana Health Plan Medicare	$5.89
Rate for Payer: UnitedHealthcare Medicare	$5.89
Rate for Payer: University Health Alliance Commercial	$13.85

VALACYCLOVIR 1 GRAM TABLET [13132]

Facility

IP

$19.00

Service Code	NDC 68084030911
Hospital Revenue Code	250
Min. Negotiated Rate	$16.15
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$11.40
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Kaiser Permanente Commercial	$17.10
Rate for Payer: MDX Hawaii PPO	$18.43

VALACYCLOVIR 1 GRAM TABLET [13132]

Facility

IP

$21.00

Service Code	NDC 50268078915
Hospital Revenue Code	250
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: MDX Hawaii PPO	$20.37

VALACYCLOVIR 1 GRAM TABLET [13132]

Facility

OP

$21.00

Service Code	NDC 50268078915
Hospital Revenue Code	637
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$20.37
Rate for Payer: AlohaCare Medicaid	$10.50
Rate for Payer: AlohaCare Medicare	$6.51
Rate for Payer: Cash Price	$12.60
Rate for Payer: Devoted Health Medicare	$7.14
Rate for Payer: Hawaii Medical Service Association Medicare	$6.51
Rate for Payer: Hawaii Western Management Group Commercial	$19.95
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Humana Medicare	$6.51
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicare	$6.51
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: Ohana Health Plan Medicaid	$6.51
Rate for Payer: Ohana Health Plan Medicare	$6.51
Rate for Payer: UnitedHealthcare Medicare	$6.51
Rate for Payer: University Health Alliance Commercial	$15.31

VALACYCLOVIR 1 GRAM TABLET [13132]

Facility

OP

$19.00

Service Code	NDC 68084030921
Hospital Revenue Code	637
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$18.43
Rate for Payer: AlohaCare Medicaid	$9.50
Rate for Payer: AlohaCare Medicare	$5.89
Rate for Payer: Cash Price	$11.40
Rate for Payer: Devoted Health Medicare	$6.46
Rate for Payer: Hawaii Medical Service Association Medicare	$5.89
Rate for Payer: Hawaii Western Management Group Commercial	$18.05
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Humana Medicare	$5.89
Rate for Payer: Kaiser Permanente Commercial	$17.10
Rate for Payer: Kaiser Permanente Medicaid	$9.69
Rate for Payer: Kaiser Permanente Medicare	$5.89
Rate for Payer: MDX Hawaii PPO	$18.43
Rate for Payer: Ohana Health Plan Medicaid	$5.89
Rate for Payer: Ohana Health Plan Medicare	$5.89
Rate for Payer: UnitedHealthcare Medicare	$5.89
Rate for Payer: University Health Alliance Commercial	$13.85

VALACYCLOVIR 500 MG TABLET [13133]

Facility

IP

$14.00

Service Code	NDC 68084021501
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$8.40
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: MDX Hawaii PPO	$13.58

VALACYCLOVIR 500 MG TABLET [13133]

Facility

IP

$14.00

Service Code	NDC 68084021511
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$8.40
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: MDX Hawaii PPO	$13.58

VALACYCLOVIR 500 MG TABLET [13133]

Facility

IP

$13.00

Service Code	NDC 68084021521
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

VALACYCLOVIR 500 MG TABLET [13133]

Facility

OP

$14.00

Service Code	NDC 68084021501
Hospital Revenue Code	637
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$13.58
Rate for Payer: AlohaCare Medicaid	$7.00
Rate for Payer: AlohaCare Medicare	$4.34
Rate for Payer: Cash Price	$8.40
Rate for Payer: Devoted Health Medicare	$4.76
Rate for Payer: Hawaii Medical Service Association Medicare	$4.34
Rate for Payer: Hawaii Western Management Group Commercial	$13.30
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Humana Medicare	$4.34
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: Kaiser Permanente Medicaid	$7.14
Rate for Payer: Kaiser Permanente Medicare	$4.34
Rate for Payer: MDX Hawaii PPO	$13.58
Rate for Payer: Ohana Health Plan Medicaid	$4.34
Rate for Payer: Ohana Health Plan Medicare	$4.34
Rate for Payer: UnitedHealthcare Medicare	$4.34
Rate for Payer: University Health Alliance Commercial	$10.20

VALACYCLOVIR 500 MG TABLET [13133]

Facility

OP

$14.00

Service Code	NDC 68084021511
Hospital Revenue Code	637
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$13.58
Rate for Payer: AlohaCare Medicaid	$7.00
Rate for Payer: AlohaCare Medicare	$4.34
Rate for Payer: Cash Price	$8.40
Rate for Payer: Devoted Health Medicare	$4.76
Rate for Payer: Hawaii Medical Service Association Medicare	$4.34
Rate for Payer: Hawaii Western Management Group Commercial	$13.30
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Humana Medicare	$4.34
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: Kaiser Permanente Medicaid	$7.14
Rate for Payer: Kaiser Permanente Medicare	$4.34
Rate for Payer: MDX Hawaii PPO	$13.58
Rate for Payer: Ohana Health Plan Medicaid	$4.34
Rate for Payer: Ohana Health Plan Medicare	$4.34
Rate for Payer: UnitedHealthcare Medicare	$4.34
Rate for Payer: University Health Alliance Commercial	$10.20

VALACYCLOVIR 500 MG TABLET [13133]

Facility

OP

$13.00

Service Code	NDC 68084021521
Hospital Revenue Code	637
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$12.61
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$4.03
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$4.42
Rate for Payer: Hawaii Medical Service Association Medicare	$4.03
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$4.03
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$4.03
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$4.03
Rate for Payer: Ohana Health Plan Medicare	$4.03
Rate for Payer: UnitedHealthcare Medicare	$4.03
Rate for Payer: University Health Alliance Commercial	$9.48

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: Kaiser Permanente Commercial	$13.50
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	$4.65
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$4.65
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$5.10
Rate for Payer: Hawaii Medical Service Association Medicare	$4.65
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$4.65
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$4.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$4.65
Rate for Payer: Ohana Health Plan Medicare	$4.65
Rate for Payer: UnitedHealthcare Medicare	$4.65
Rate for Payer: University Health Alliance Commercial	$10.93

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: Kaiser Permanente Commercial	$5,270.40
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

OP

$5,856.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,815.36
Max. Negotiated Rate	$5,680.32
Rate for Payer: AlohaCare Medicaid	$2,928.00
Rate for Payer: AlohaCare Medicare	$1,815.36
Rate for Payer: Cash Price	$3,513.60
Rate for Payer: Devoted Health Medicare	$1,991.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,815.36
Rate for Payer: Hawaii Western Management Group Commercial	$4,099.20
Rate for Payer: Health Management Network Commercial	$4,977.60
Rate for Payer: Humana Medicare	$1,815.36
Rate for Payer: Kaiser Permanente Commercial	$5,270.40
Rate for Payer: Kaiser Permanente Medicaid	$2,986.56
Rate for Payer: Kaiser Permanente Medicare	$1,815.36
Rate for Payer: MDX Hawaii PPO	$5,680.32
Rate for Payer: Ohana Health Plan Medicaid	$1,815.36
Rate for Payer: Ohana Health Plan Medicare	$1,815.36
Rate for Payer: UnitedHealthcare Medicare	$1,815.36
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: Kaiser Permanente Commercial	$43.20
Rate for Payer: MDX Hawaii PPO	$46.56

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