Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE [14626]

Facility

IP

$7.00

Service Code	NDC 60687050411
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

VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE [14626]

Facility

OP

$6.00

Service Code	NDC 75834015801
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

VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE [14626]

Facility

IP

$7.00

Service Code	NDC 60687050401
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

VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE [14626]

Facility

OP

$7.00

Service Code	NDC 60687050401
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

VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE [14626]

Facility

OP

$7.00

Service Code	NDC 60687050411
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

VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE [13073]

Facility

IP

$6.00

Service Code	NDC 75834015901
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

VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE [13073]

Facility

OP

$6.00

Service Code	NDC 75834015901
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

VERSA-DIAL TI TAPER 118001

Facility

OP

$563.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$287.13
Max. Negotiated Rate	$546.11
Rate for Payer: Cash Price	$337.80
Rate for Payer: Hawaii Western Management Group Commercial	$394.10
Rate for Payer: Health Management Network Commercial	$478.55
Rate for Payer: Kaiser Permanente Commercial	$354.69
Rate for Payer: Kaiser Permanente Medicaid	$287.13
Rate for Payer: MDX Hawaii PPO	$546.11
Rate for Payer: University Health Alliance Commercial	$315.28

VERSA-DIAL TI TAPER 118001

Facility

IP

$563.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$315.28
Max. Negotiated Rate	$546.11
Rate for Payer: Cash Price	$337.80
Rate for Payer: Hawaii Western Management Group Commercial	$394.10
Rate for Payer: Health Management Network Commercial	$478.55
Rate for Payer: MDX Hawaii PPO	$546.11
Rate for Payer: University Health Alliance Commercial	$315.28

VERSAJET II HANDSET 45DEG/14MM

Facility

IP

$1,587.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,348.95
Max. Negotiated Rate	$1,539.39
Rate for Payer: Cash Price	$952.20
Rate for Payer: Health Management Network Commercial	$1,348.95
Rate for Payer: MDX Hawaii PPO	$1,539.39

VERSAJET II HANDSET 45DEG/14MM

Facility

OP

$1,587.00

Hospital Revenue Code	272
Min. Negotiated Rate	$809.37
Max. Negotiated Rate	$1,539.39
Rate for Payer: Cash Price	$952.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,507.65
Rate for Payer: Health Management Network Commercial	$1,348.95
Rate for Payer: Kaiser Permanente Commercial	$999.81
Rate for Payer: Kaiser Permanente Medicaid	$809.37
Rate for Payer: MDX Hawaii PPO	$1,539.39
Rate for Payer: University Health Alliance Commercial	$1,156.76

VERSAJET II HANDSET 45DEG/8MM

Facility

OP

$1,587.00

Hospital Revenue Code	272
Min. Negotiated Rate	$809.37
Max. Negotiated Rate	$1,539.39
Rate for Payer: Cash Price	$952.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,507.65
Rate for Payer: Health Management Network Commercial	$1,348.95
Rate for Payer: Kaiser Permanente Commercial	$999.81
Rate for Payer: Kaiser Permanente Medicaid	$809.37
Rate for Payer: MDX Hawaii PPO	$1,539.39
Rate for Payer: University Health Alliance Commercial	$1,156.76

VERSAJET II HANDSET 45DEG/8MM

Facility

IP

$1,587.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,348.95
Max. Negotiated Rate	$1,539.39
Rate for Payer: Cash Price	$952.20
Rate for Payer: Health Management Network Commercial	$1,348.95
Rate for Payer: MDX Hawaii PPO	$1,539.39

VERSAPORT OPT 5MM ONB5STF

Facility

IP

$119.00

Hospital Revenue Code	272
Min. Negotiated Rate	$101.15
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$71.40
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: MDX Hawaii PPO	$115.43

VERSAPORT OPT 5MM ONB5STF

Facility

OP

$119.00

Hospital Revenue Code	272
Min. Negotiated Rate	$60.69
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$71.40
Rate for Payer: Hawaii Western Management Group Commercial	$113.05
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Kaiser Permanente Commercial	$74.97
Rate for Payer: Kaiser Permanente Medicaid	$60.69
Rate for Payer: MDX Hawaii PPO	$115.43
Rate for Payer: University Health Alliance Commercial	$86.74

VERSAPORT PLUS BLADELESS CANN

Facility

OP

$166.00

Hospital Revenue Code	272
Min. Negotiated Rate	$84.66
Max. Negotiated Rate	$161.02
Rate for Payer: Cash Price	$99.60
Rate for Payer: Hawaii Western Management Group Commercial	$157.70
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Kaiser Permanente Commercial	$104.58
Rate for Payer: Kaiser Permanente Medicaid	$84.66
Rate for Payer: MDX Hawaii PPO	$161.02
Rate for Payer: University Health Alliance Commercial	$121.00

VERSAPORT PLUS BLADELESS CANN

Facility

IP

$166.00

Hospital Revenue Code	272
Min. Negotiated Rate	$141.10
Max. Negotiated Rate	$161.02
Rate for Payer: Cash Price	$99.60
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: MDX Hawaii PPO	$161.02

VERSASTEP 12MM LONG

Facility

OP

$214.00

Hospital Revenue Code	272
Min. Negotiated Rate	$109.14
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Hawaii Western Management Group Commercial	$203.30
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Kaiser Permanente Commercial	$134.82
Rate for Payer: Kaiser Permanente Medicaid	$109.14
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: University Health Alliance Commercial	$155.98

VERSASTEP 12MM LONG

Facility

IP

$214.00

Hospital Revenue Code	272
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: MDX Hawaii PPO	$207.58

VERSASTEP 5MM LONG

Facility

IP

$214.00

Hospital Revenue Code	272
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: MDX Hawaii PPO	$207.58

VERSASTEP 5MM LONG

Facility

OP

$214.00

Hospital Revenue Code	272
Min. Negotiated Rate	$109.14
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Hawaii Western Management Group Commercial	$203.30
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Kaiser Permanente Commercial	$134.82
Rate for Payer: Kaiser Permanente Medicaid	$109.14
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: University Health Alliance Commercial	$155.98

VERSASTEP XTRA SLEEVE

Facility

IP

$226.00

Hospital Revenue Code	272
Min. Negotiated Rate	$192.10
Max. Negotiated Rate	$219.22
Rate for Payer: Cash Price	$135.60
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: MDX Hawaii PPO	$219.22

VERSASTEP XTRA SLEEVE

Facility

OP

$226.00

Hospital Revenue Code	272
Min. Negotiated Rate	$115.26
Max. Negotiated Rate	$219.22
Rate for Payer: Cash Price	$135.60
Rate for Payer: Hawaii Western Management Group Commercial	$214.70
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: Kaiser Permanente Commercial	$142.38
Rate for Payer: Kaiser Permanente Medicaid	$115.26
Rate for Payer: MDX Hawaii PPO	$219.22
Rate for Payer: University Health Alliance Commercial	$164.73

VERS DSTL 10MM 00-7859-010-00

Facility

IP

$200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Hawaii Western Management Group Commercial	$140.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: University Health Alliance Commercial	$112.00

VERS DSTL 10MM 00-7859-010-00

Facility

OP

$200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Hawaii Western Management Group Commercial	$140.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: University Health Alliance Commercial	$112.00