Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

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

Facility

$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: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$6.79

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

Facility

$7.00

Service Code	NDC 60687050411
Hospital Revenue Code	637
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$6.79
Rate for Payer: AlohaCare Medicaid	$3.50
Rate for Payer: AlohaCare Medicare	$5.32
Rate for Payer: Cash Price	$4.20
Rate for Payer: Devoted Health Medicare	$5.88
Rate for Payer: Hawaii Medical Service Association Medicare	$5.32
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Humana Medicare	$5.32
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: Kaiser Permanente Medicare	$5.32
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: Ohana Health Plan Medicaid	$5.32
Rate for Payer: Ohana Health Plan Medicare	$5.32
Rate for Payer: UnitedHealthcare Medicare	$5.32
Rate for Payer: University Health Alliance Commercial	$5.10

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

Facility

$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: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$6.79

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

Facility

$6.00

Service Code	NDC 75834015901
Hospital Revenue Code	637
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$4.56
Rate for Payer: Cash Price	$3.60
Rate for Payer: Devoted Health Medicare	$5.04
Rate for Payer: Hawaii Medical Service Association Medicare	$4.56
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$4.56
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$4.56
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$4.56
Rate for Payer: Ohana Health Plan Medicare	$4.56
Rate for Payer: UnitedHealthcare Medicare	$4.56
Rate for Payer: University Health Alliance Commercial	$4.37

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

Facility

$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: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

VERSA-DIAL TI TAPER 118001

Facility

$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: Kaiser Permanente Commercial	$506.70
Rate for Payer: MDX Hawaii PPO	$546.11
Rate for Payer: University Health Alliance Commercial	$315.28

VERSA-DIAL TI TAPER 118001

Facility

$563.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$281.50
Max. Negotiated Rate	$546.11
Rate for Payer: AlohaCare Medicaid	$281.50
Rate for Payer: AlohaCare Medicare	$427.88
Rate for Payer: Cash Price	$337.80
Rate for Payer: Devoted Health Medicare	$472.92
Rate for Payer: Hawaii Medical Service Association Medicare	$427.88
Rate for Payer: Hawaii Western Management Group Commercial	$394.10
Rate for Payer: Health Management Network Commercial	$478.55
Rate for Payer: Humana Medicare	$427.88
Rate for Payer: Kaiser Permanente Commercial	$506.70
Rate for Payer: Kaiser Permanente Medicaid	$287.13
Rate for Payer: Kaiser Permanente Medicare	$427.88
Rate for Payer: MDX Hawaii PPO	$546.11
Rate for Payer: Ohana Health Plan Medicaid	$427.88
Rate for Payer: Ohana Health Plan Medicare	$427.88
Rate for Payer: UnitedHealthcare Medicare	$427.88
Rate for Payer: University Health Alliance Commercial	$315.28

VERSAJET II HANDSET 45DEG/14MM

Facility

$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: Kaiser Permanente Commercial	$1,428.30
Rate for Payer: MDX Hawaii PPO	$1,539.39

VERSAJET II HANDSET 45DEG/14MM

Facility

$1,587.00

Hospital Revenue Code	272
Min. Negotiated Rate	$793.50
Max. Negotiated Rate	$1,539.39
Rate for Payer: AlohaCare Medicaid	$793.50
Rate for Payer: AlohaCare Medicare	$1,206.12
Rate for Payer: Cash Price	$952.20
Rate for Payer: Devoted Health Medicare	$1,333.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,206.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,507.65
Rate for Payer: Health Management Network Commercial	$1,348.95
Rate for Payer: Humana Medicare	$1,206.12
Rate for Payer: Kaiser Permanente Commercial	$1,428.30
Rate for Payer: Kaiser Permanente Medicaid	$809.37
Rate for Payer: Kaiser Permanente Medicare	$1,206.12
Rate for Payer: MDX Hawaii PPO	$1,539.39
Rate for Payer: Ohana Health Plan Medicaid	$1,206.12
Rate for Payer: Ohana Health Plan Medicare	$1,206.12
Rate for Payer: UnitedHealthcare Medicare	$1,206.12
Rate for Payer: University Health Alliance Commercial	$1,156.76

VERSAJET II HANDSET 45DEG/8MM

Facility

$1,587.00

Hospital Revenue Code	272
Min. Negotiated Rate	$793.50
Max. Negotiated Rate	$1,539.39
Rate for Payer: AlohaCare Medicaid	$793.50
Rate for Payer: AlohaCare Medicare	$1,206.12
Rate for Payer: Cash Price	$952.20
Rate for Payer: Devoted Health Medicare	$1,333.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,206.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,507.65
Rate for Payer: Health Management Network Commercial	$1,348.95
Rate for Payer: Humana Medicare	$1,206.12
Rate for Payer: Kaiser Permanente Commercial	$1,428.30
Rate for Payer: Kaiser Permanente Medicaid	$809.37
Rate for Payer: Kaiser Permanente Medicare	$1,206.12
Rate for Payer: MDX Hawaii PPO	$1,539.39
Rate for Payer: Ohana Health Plan Medicaid	$1,206.12
Rate for Payer: Ohana Health Plan Medicare	$1,206.12
Rate for Payer: UnitedHealthcare Medicare	$1,206.12
Rate for Payer: University Health Alliance Commercial	$1,156.76

VERSAJET II HANDSET 45DEG/8MM

Facility

$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: Kaiser Permanente Commercial	$1,428.30
Rate for Payer: MDX Hawaii PPO	$1,539.39

VERSAPORT OPT 5MM ONB5STF

Facility

$119.00

Hospital Revenue Code	272
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$115.43
Rate for Payer: AlohaCare Medicaid	$59.50
Rate for Payer: AlohaCare Medicare	$90.44
Rate for Payer: Cash Price	$71.40
Rate for Payer: Devoted Health Medicare	$99.96
Rate for Payer: Hawaii Medical Service Association Medicare	$90.44
Rate for Payer: Hawaii Western Management Group Commercial	$113.05
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Humana Medicare	$90.44
Rate for Payer: Kaiser Permanente Commercial	$107.10
Rate for Payer: Kaiser Permanente Medicaid	$60.69
Rate for Payer: Kaiser Permanente Medicare	$90.44
Rate for Payer: MDX Hawaii PPO	$115.43
Rate for Payer: Ohana Health Plan Medicaid	$90.44
Rate for Payer: Ohana Health Plan Medicare	$90.44
Rate for Payer: UnitedHealthcare Medicare	$90.44
Rate for Payer: University Health Alliance Commercial	$86.74

VERSAPORT OPT 5MM ONB5STF

Facility

$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: Kaiser Permanente Commercial	$107.10
Rate for Payer: MDX Hawaii PPO	$115.43

VERSAPORT PLUS BLADELESS CANN

Facility

$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: Kaiser Permanente Commercial	$149.40
Rate for Payer: MDX Hawaii PPO	$161.02

VERSAPORT PLUS BLADELESS CANN

Facility

$166.00

Hospital Revenue Code	272
Min. Negotiated Rate	$83.00
Max. Negotiated Rate	$161.02
Rate for Payer: AlohaCare Medicaid	$83.00
Rate for Payer: AlohaCare Medicare	$126.16
Rate for Payer: Cash Price	$99.60
Rate for Payer: Devoted Health Medicare	$139.44
Rate for Payer: Hawaii Medical Service Association Medicare	$126.16
Rate for Payer: Hawaii Western Management Group Commercial	$157.70
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Humana Medicare	$126.16
Rate for Payer: Kaiser Permanente Commercial	$149.40
Rate for Payer: Kaiser Permanente Medicaid	$84.66
Rate for Payer: Kaiser Permanente Medicare	$126.16
Rate for Payer: MDX Hawaii PPO	$161.02
Rate for Payer: Ohana Health Plan Medicaid	$126.16
Rate for Payer: Ohana Health Plan Medicare	$126.16
Rate for Payer: UnitedHealthcare Medicare	$126.16
Rate for Payer: University Health Alliance Commercial	$121.00

VERSASTEP 12MM LONG

Facility

$214.00

Hospital Revenue Code	272
Min. Negotiated Rate	$107.00
Max. Negotiated Rate	$207.58
Rate for Payer: AlohaCare Medicaid	$107.00
Rate for Payer: AlohaCare Medicare	$162.64
Rate for Payer: Cash Price	$128.40
Rate for Payer: Devoted Health Medicare	$179.76
Rate for Payer: Hawaii Medical Service Association Medicare	$162.64
Rate for Payer: Hawaii Western Management Group Commercial	$203.30
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Humana Medicare	$162.64
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: Kaiser Permanente Medicaid	$109.14
Rate for Payer: Kaiser Permanente Medicare	$162.64
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: Ohana Health Plan Medicaid	$162.64
Rate for Payer: Ohana Health Plan Medicare	$162.64
Rate for Payer: UnitedHealthcare Medicare	$162.64
Rate for Payer: University Health Alliance Commercial	$155.98

VERSASTEP 12MM LONG

Facility

$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: Kaiser Permanente Commercial	$192.60
Rate for Payer: MDX Hawaii PPO	$207.58

VERSASTEP 5MM LONG

Facility

$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: Kaiser Permanente Commercial	$192.60
Rate for Payer: MDX Hawaii PPO	$207.58

VERSASTEP 5MM LONG

Facility

$214.00

Hospital Revenue Code	272
Min. Negotiated Rate	$107.00
Max. Negotiated Rate	$207.58
Rate for Payer: AlohaCare Medicaid	$107.00
Rate for Payer: AlohaCare Medicare	$162.64
Rate for Payer: Cash Price	$128.40
Rate for Payer: Devoted Health Medicare	$179.76
Rate for Payer: Hawaii Medical Service Association Medicare	$162.64
Rate for Payer: Hawaii Western Management Group Commercial	$203.30
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Humana Medicare	$162.64
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: Kaiser Permanente Medicaid	$109.14
Rate for Payer: Kaiser Permanente Medicare	$162.64
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: Ohana Health Plan Medicaid	$162.64
Rate for Payer: Ohana Health Plan Medicare	$162.64
Rate for Payer: UnitedHealthcare Medicare	$162.64
Rate for Payer: University Health Alliance Commercial	$155.98

VERSASTEP XTRA SLEEVE

Facility

$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: Kaiser Permanente Commercial	$203.40
Rate for Payer: MDX Hawaii PPO	$219.22

VERSASTEP XTRA SLEEVE

Facility

$226.00

Hospital Revenue Code	272
Min. Negotiated Rate	$113.00
Max. Negotiated Rate	$219.22
Rate for Payer: AlohaCare Medicaid	$113.00
Rate for Payer: AlohaCare Medicare	$171.76
Rate for Payer: Cash Price	$135.60
Rate for Payer: Devoted Health Medicare	$189.84
Rate for Payer: Hawaii Medical Service Association Medicare	$171.76
Rate for Payer: Hawaii Western Management Group Commercial	$214.70
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: Humana Medicare	$171.76
Rate for Payer: Kaiser Permanente Commercial	$203.40
Rate for Payer: Kaiser Permanente Medicaid	$115.26
Rate for Payer: Kaiser Permanente Medicare	$171.76
Rate for Payer: MDX Hawaii PPO	$219.22
Rate for Payer: Ohana Health Plan Medicaid	$171.76
Rate for Payer: Ohana Health Plan Medicare	$171.76
Rate for Payer: UnitedHealthcare Medicare	$171.76
Rate for Payer: University Health Alliance Commercial	$164.73

VERS DSTL 10MM 00-7859-010-00

Facility

$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: Kaiser Permanente Commercial	$180.00
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

$200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$100.00
Rate for Payer: AlohaCare Medicare	$152.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Devoted Health Medicare	$168.00
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Western Management Group Commercial	$140.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$152.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$152.00
Rate for Payer: Ohana Health Plan Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: University Health Alliance Commercial	$112.00

VERSYS CEMENTED LD/FX 14X135MM

Facility

$4,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

VERSYS CEMENTED LD/FX 14X135MM

Facility

$4,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,150.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: AlohaCare Medicaid	$2,150.00
Rate for Payer: AlohaCare Medicare	$3,268.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Devoted Health Medicare	$3,612.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,268.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Humana Medicare	$3,268.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: Kaiser Permanente Medicare	$3,268.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: Ohana Health Plan Medicaid	$3,268.00
Rate for Payer: Ohana Health Plan Medicare	$3,268.00
Rate for Payer: UnitedHealthcare Medicare	$3,268.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

Know your out-of-pocket cost for care.

All Charges