Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$215.73

Service Code	NDC 65862052890
Hospital Charge Code	27858
Hospital Revenue Code	637
Min. Negotiated Rate	$140.22
Max. Negotiated Rate	$215.73
Rate for Payer: Aetna Commercial	$194.16
Rate for Payer: ASR ASR	$209.26
Rate for Payer: ASR Commercial	$209.26
Rate for Payer: BCBS Trust/PPO	$175.80
Rate for Payer: BCN Commercial	$167.26
Rate for Payer: Cash Price	$172.58
Rate for Payer: Cofinity Commercial	$202.79
Rate for Payer: Encore Health Key Benefits Commercial	$172.58
Rate for Payer: Healthscope Commercial	$215.73
Rate for Payer: Healthscope Whirlpool	$209.26
Rate for Payer: Mclaren Commercial	$194.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$183.37
Rate for Payer: Nomi Health Commercial	$176.90
Rate for Payer: Priority Health Cigna Priority Health	$140.22
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$189.84

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$302.10

Service Code	NDC 00904707761
Hospital Charge Code	27858
Hospital Revenue Code	637
Min. Negotiated Rate	$196.37
Max. Negotiated Rate	$302.10
Rate for Payer: Aetna Commercial	$271.89
Rate for Payer: ASR ASR	$293.04
Rate for Payer: ASR Commercial	$293.04
Rate for Payer: BCBS Trust/PPO	$246.18
Rate for Payer: BCN Commercial	$234.22
Rate for Payer: Cash Price	$241.68
Rate for Payer: Cofinity Commercial	$283.97
Rate for Payer: Encore Health Key Benefits Commercial	$241.68
Rate for Payer: Healthscope Commercial	$302.10
Rate for Payer: Healthscope Whirlpool	$293.04
Rate for Payer: Mclaren Commercial	$271.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$256.79
Rate for Payer: Nomi Health Commercial	$247.72
Rate for Payer: Priority Health Cigna Priority Health	$196.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$265.85

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$463.60

Service Code	NDC 68084070901
Hospital Charge Code	27858
Hospital Revenue Code	637
Min. Negotiated Rate	$185.44
Max. Negotiated Rate	$463.60
Rate for Payer: Aetna Commercial	$417.24
Rate for Payer: Aetna Medicare	$231.80
Rate for Payer: ASR ASR	$449.69
Rate for Payer: ASR Commercial	$449.69
Rate for Payer: BCBS Complete	$185.44
Rate for Payer: BCBS Trust/PPO	$379.64
Rate for Payer: BCN Commercial	$359.43
Rate for Payer: Cash Price	$370.88
Rate for Payer: Cofinity Commercial	$435.78
Rate for Payer: Encore Health Key Benefits Commercial	$370.88
Rate for Payer: Healthscope Commercial	$463.60
Rate for Payer: Healthscope Whirlpool	$449.69
Rate for Payer: Mclaren Commercial	$417.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$394.06
Rate for Payer: Nomi Health Commercial	$380.15
Rate for Payer: Priority Health Cigna Priority Health	$301.34
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$406.21
Rate for Payer: Priority Health Narrow Network	$324.98
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$407.97

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$463.60

Service Code	NDC 68084070901
Hospital Charge Code	27858
Hospital Revenue Code	637
Min. Negotiated Rate	$301.34
Max. Negotiated Rate	$463.60
Rate for Payer: Aetna Commercial	$417.24
Rate for Payer: ASR ASR	$449.69
Rate for Payer: ASR Commercial	$449.69
Rate for Payer: BCBS Trust/PPO	$377.79
Rate for Payer: BCN Commercial	$359.43
Rate for Payer: Cash Price	$370.88
Rate for Payer: Cofinity Commercial	$435.78
Rate for Payer: Encore Health Key Benefits Commercial	$370.88
Rate for Payer: Healthscope Commercial	$463.60
Rate for Payer: Healthscope Whirlpool	$449.69
Rate for Payer: Mclaren Commercial	$417.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$394.06
Rate for Payer: Nomi Health Commercial	$380.15
Rate for Payer: Priority Health Cigna Priority Health	$301.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$407.97

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$4.64

Service Code	NDC 68084070911
Hospital Charge Code	27858
Hospital Revenue Code	637
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$4.64
Rate for Payer: Aetna Commercial	$4.18
Rate for Payer: Aetna Medicare	$2.32
Rate for Payer: ASR ASR	$4.50
Rate for Payer: ASR Commercial	$4.50
Rate for Payer: BCBS Complete	$1.86
Rate for Payer: BCBS Trust/PPO	$3.80
Rate for Payer: BCN Commercial	$3.60
Rate for Payer: Cash Price	$3.71
Rate for Payer: Cofinity Commercial	$4.36
Rate for Payer: Encore Health Key Benefits Commercial	$3.71
Rate for Payer: Healthscope Commercial	$4.64
Rate for Payer: Healthscope Whirlpool	$4.50
Rate for Payer: Mclaren Commercial	$4.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.94
Rate for Payer: Nomi Health Commercial	$3.80
Rate for Payer: Priority Health Cigna Priority Health	$3.02
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4.07
Rate for Payer: Priority Health Narrow Network	$3.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4.08

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$226.57

Service Code	NDC 00093738598
Hospital Charge Code	27858
Hospital Revenue Code	637
Min. Negotiated Rate	$147.27
Max. Negotiated Rate	$226.57
Rate for Payer: Aetna Commercial	$203.91
Rate for Payer: ASR ASR	$219.77
Rate for Payer: ASR Commercial	$219.77
Rate for Payer: BCBS Trust/PPO	$184.63
Rate for Payer: BCN Commercial	$175.66
Rate for Payer: Cash Price	$181.26
Rate for Payer: Cofinity Commercial	$212.98
Rate for Payer: Encore Health Key Benefits Commercial	$181.26
Rate for Payer: Healthscope Commercial	$226.57
Rate for Payer: Healthscope Whirlpool	$219.77
Rate for Payer: Mclaren Commercial	$203.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$192.58
Rate for Payer: Nomi Health Commercial	$185.79
Rate for Payer: Priority Health Cigna Priority Health	$147.27
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$199.38

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$4.64

Service Code	NDC 68084070911
Hospital Charge Code	27858
Hospital Revenue Code	637
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$4.64
Rate for Payer: Aetna Commercial	$4.18
Rate for Payer: ASR ASR	$4.50
Rate for Payer: ASR Commercial	$4.50
Rate for Payer: BCBS Trust/PPO	$3.78
Rate for Payer: BCN Commercial	$3.60
Rate for Payer: Cash Price	$3.71
Rate for Payer: Cofinity Commercial	$4.36
Rate for Payer: Encore Health Key Benefits Commercial	$3.71
Rate for Payer: Healthscope Commercial	$4.64
Rate for Payer: Healthscope Whirlpool	$4.50
Rate for Payer: Mclaren Commercial	$4.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.94
Rate for Payer: Nomi Health Commercial	$3.80
Rate for Payer: Priority Health Cigna Priority Health	$3.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4.08

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$302.10

Service Code	NDC 00904707761
Hospital Charge Code	27858
Hospital Revenue Code	637
Min. Negotiated Rate	$120.84
Max. Negotiated Rate	$302.10
Rate for Payer: Aetna Commercial	$271.89
Rate for Payer: Aetna Medicare	$151.05
Rate for Payer: ASR ASR	$293.04
Rate for Payer: ASR Commercial	$293.04
Rate for Payer: BCBS Complete	$120.84
Rate for Payer: BCBS Trust/PPO	$247.39
Rate for Payer: BCN Commercial	$234.22
Rate for Payer: Cash Price	$241.68
Rate for Payer: Cofinity Commercial	$283.97
Rate for Payer: Encore Health Key Benefits Commercial	$241.68
Rate for Payer: Healthscope Commercial	$302.10
Rate for Payer: Healthscope Whirlpool	$293.04
Rate for Payer: Mclaren Commercial	$271.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$256.79
Rate for Payer: Nomi Health Commercial	$247.72
Rate for Payer: Priority Health Cigna Priority Health	$196.37
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$264.70
Rate for Payer: Priority Health Narrow Network	$211.77
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$265.85

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$215.73

Service Code	NDC 65862052890
Hospital Charge Code	27858
Hospital Revenue Code	637
Min. Negotiated Rate	$86.29
Max. Negotiated Rate	$215.73
Rate for Payer: Aetna Commercial	$194.16
Rate for Payer: Aetna Medicare	$107.86
Rate for Payer: ASR ASR	$209.26
Rate for Payer: ASR Commercial	$209.26
Rate for Payer: BCBS Complete	$86.29
Rate for Payer: BCBS Trust/PPO	$176.66
Rate for Payer: BCN Commercial	$167.26
Rate for Payer: Cash Price	$172.58
Rate for Payer: Cofinity Commercial	$202.79
Rate for Payer: Encore Health Key Benefits Commercial	$172.58
Rate for Payer: Healthscope Commercial	$215.73
Rate for Payer: Healthscope Whirlpool	$209.26
Rate for Payer: Mclaren Commercial	$194.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$183.37
Rate for Payer: Nomi Health Commercial	$176.90
Rate for Payer: Priority Health Cigna Priority Health	$140.22
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$189.02
Rate for Payer: Priority Health Narrow Network	$151.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$189.84

VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER

Facility

$47.60

Service Code	NDC 00054074287
Hospital Charge Code	32309
Hospital Revenue Code	637
Min. Negotiated Rate	$30.94
Max. Negotiated Rate	$47.60
Rate for Payer: Aetna Commercial	$42.84
Rate for Payer: ASR ASR	$46.17
Rate for Payer: ASR Commercial	$46.17
Rate for Payer: BCBS Trust/PPO	$38.79
Rate for Payer: BCN Commercial	$36.90
Rate for Payer: Cash Price	$38.08
Rate for Payer: Cofinity Commercial	$44.74
Rate for Payer: Encore Health Key Benefits Commercial	$38.08
Rate for Payer: Healthscope Commercial	$47.60
Rate for Payer: Healthscope Whirlpool	$46.17
Rate for Payer: Mclaren Commercial	$42.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.46
Rate for Payer: Nomi Health Commercial	$39.03
Rate for Payer: Priority Health Cigna Priority Health	$30.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$41.89

VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER

Facility

$47.60

Service Code	NDC 00054074287
Hospital Charge Code	32309
Hospital Revenue Code	637
Min. Negotiated Rate	$19.04
Max. Negotiated Rate	$47.60
Rate for Payer: Aetna Commercial	$42.84
Rate for Payer: Aetna Medicare	$23.80
Rate for Payer: ASR ASR	$46.17
Rate for Payer: ASR Commercial	$46.17
Rate for Payer: BCBS Complete	$19.04
Rate for Payer: BCBS Trust/PPO	$38.98
Rate for Payer: BCN Commercial	$36.90
Rate for Payer: Cash Price	$38.08
Rate for Payer: Cofinity Commercial	$44.74
Rate for Payer: Encore Health Key Benefits Commercial	$38.08
Rate for Payer: Healthscope Commercial	$47.60
Rate for Payer: Healthscope Whirlpool	$46.17
Rate for Payer: Mclaren Commercial	$42.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.46
Rate for Payer: Nomi Health Commercial	$39.03
Rate for Payer: Priority Health Cigna Priority Health	$30.94
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$41.71
Rate for Payer: Priority Health Narrow Network	$33.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$41.89

VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER

Facility

$174.30

Service Code	NDC 00173068220
Hospital Charge Code	32309
Hospital Revenue Code	637
Min. Negotiated Rate	$69.72
Max. Negotiated Rate	$174.30
Rate for Payer: Aetna Commercial	$156.87
Rate for Payer: Aetna Medicare	$87.15
Rate for Payer: ASR ASR	$169.07
Rate for Payer: ASR Commercial	$169.07
Rate for Payer: BCBS Complete	$69.72
Rate for Payer: BCBS Trust/PPO	$142.73
Rate for Payer: BCN Commercial	$135.13
Rate for Payer: Cash Price	$139.44
Rate for Payer: Cofinity Commercial	$163.84
Rate for Payer: Encore Health Key Benefits Commercial	$139.44
Rate for Payer: Healthscope Commercial	$174.30
Rate for Payer: Healthscope Whirlpool	$169.07
Rate for Payer: Mclaren Commercial	$156.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$148.16
Rate for Payer: Nomi Health Commercial	$142.93
Rate for Payer: Priority Health Cigna Priority Health	$113.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$152.72
Rate for Payer: Priority Health Narrow Network	$122.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$153.38

VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER

Facility

$66.78

Service Code	NDC 00173068224
Hospital Charge Code	32309
Hospital Revenue Code	637
Min. Negotiated Rate	$43.41
Max. Negotiated Rate	$66.78
Rate for Payer: Aetna Commercial	$60.10
Rate for Payer: ASR ASR	$64.78
Rate for Payer: ASR Commercial	$64.78
Rate for Payer: BCBS Trust/PPO	$54.42
Rate for Payer: BCN Commercial	$51.77
Rate for Payer: Cash Price	$53.42
Rate for Payer: Cofinity Commercial	$62.77
Rate for Payer: Encore Health Key Benefits Commercial	$53.42
Rate for Payer: Healthscope Commercial	$66.78
Rate for Payer: Healthscope Whirlpool	$64.78
Rate for Payer: Mclaren Commercial	$60.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.76
Rate for Payer: Nomi Health Commercial	$54.76
Rate for Payer: Priority Health Cigna Priority Health	$43.41
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$58.77

VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER

Facility

$174.30

Service Code	NDC 00173068220
Hospital Charge Code	32309
Hospital Revenue Code	637
Min. Negotiated Rate	$113.30
Max. Negotiated Rate	$174.30
Rate for Payer: Aetna Commercial	$156.87
Rate for Payer: ASR ASR	$169.07
Rate for Payer: ASR Commercial	$169.07
Rate for Payer: BCBS Trust/PPO	$142.04
Rate for Payer: BCN Commercial	$135.13
Rate for Payer: Cash Price	$139.44
Rate for Payer: Cofinity Commercial	$163.84
Rate for Payer: Encore Health Key Benefits Commercial	$139.44
Rate for Payer: Healthscope Commercial	$174.30
Rate for Payer: Healthscope Whirlpool	$169.07
Rate for Payer: Mclaren Commercial	$156.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$148.16
Rate for Payer: Nomi Health Commercial	$142.93
Rate for Payer: Priority Health Cigna Priority Health	$113.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$153.38

VENTOLIN HFA 90 MCG/ACTUATION AEROSOL INHALER

Facility

$66.78

Service Code	NDC 00173068224
Hospital Charge Code	32309
Hospital Revenue Code	637
Min. Negotiated Rate	$26.71
Max. Negotiated Rate	$66.78
Rate for Payer: Aetna Commercial	$60.10
Rate for Payer: Aetna Medicare	$33.39
Rate for Payer: ASR ASR	$64.78
Rate for Payer: ASR Commercial	$64.78
Rate for Payer: BCBS Complete	$26.71
Rate for Payer: BCBS Trust/PPO	$54.69
Rate for Payer: BCN Commercial	$51.77
Rate for Payer: Cash Price	$53.42
Rate for Payer: Cofinity Commercial	$62.77
Rate for Payer: Encore Health Key Benefits Commercial	$53.42
Rate for Payer: Healthscope Commercial	$66.78
Rate for Payer: Healthscope Whirlpool	$64.78
Rate for Payer: Mclaren Commercial	$60.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.76
Rate for Payer: Nomi Health Commercial	$54.76
Rate for Payer: Priority Health Cigna Priority Health	$43.41
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$58.51
Rate for Payer: Priority Health Narrow Network	$46.81
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$58.77

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION

Facility

$113.39

Service Code	NDC 00409114405
Hospital Charge Code	8527
Hospital Revenue Code	250
Min. Negotiated Rate	$73.70
Max. Negotiated Rate	$113.39
Rate for Payer: Aetna Commercial	$102.05
Rate for Payer: ASR ASR	$109.99
Rate for Payer: ASR Commercial	$109.99
Rate for Payer: BCBS Trust/PPO	$92.40
Rate for Payer: BCN Commercial	$87.91
Rate for Payer: Cash Price	$90.72
Rate for Payer: Cofinity Commercial	$106.59
Rate for Payer: Encore Health Key Benefits Commercial	$90.71
Rate for Payer: Healthscope Commercial	$113.39
Rate for Payer: Healthscope Whirlpool	$109.99
Rate for Payer: Mclaren Commercial	$102.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$96.38
Rate for Payer: Nomi Health Commercial	$92.98
Rate for Payer: Priority Health Cigna Priority Health	$73.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$99.78

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION

Facility

$18.26

Service Code	NDC 70756060582
Hospital Charge Code	8527
Hospital Revenue Code	250
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$18.26
Rate for Payer: Aetna Commercial	$16.43
Rate for Payer: Aetna Medicare	$9.13
Rate for Payer: ASR ASR	$17.71
Rate for Payer: ASR Commercial	$17.71
Rate for Payer: BCBS Complete	$7.30
Rate for Payer: BCBS Trust/PPO	$14.95
Rate for Payer: BCN Commercial	$14.16
Rate for Payer: Cash Price	$14.61
Rate for Payer: Cofinity Commercial	$17.16
Rate for Payer: Encore Health Key Benefits Commercial	$14.61
Rate for Payer: Healthscope Commercial	$18.26
Rate for Payer: Healthscope Whirlpool	$17.71
Rate for Payer: Mclaren Commercial	$16.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.52
Rate for Payer: Nomi Health Commercial	$14.97
Rate for Payer: Priority Health Cigna Priority Health	$11.87
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.00
Rate for Payer: Priority Health Narrow Network	$12.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.07

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION

Facility

$26.58

Service Code	NDC 67850007125
Hospital Charge Code	8527
Hospital Revenue Code	250
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$26.58
Rate for Payer: Aetna Commercial	$23.92
Rate for Payer: ASR ASR	$25.78
Rate for Payer: ASR Commercial	$25.78
Rate for Payer: BCBS Trust/PPO	$21.66
Rate for Payer: BCN Commercial	$20.61
Rate for Payer: Cash Price	$21.26
Rate for Payer: Cofinity Commercial	$24.99
Rate for Payer: Encore Health Key Benefits Commercial	$21.26
Rate for Payer: Healthscope Commercial	$26.58
Rate for Payer: Healthscope Whirlpool	$25.78
Rate for Payer: Mclaren Commercial	$23.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.59
Rate for Payer: Nomi Health Commercial	$21.80
Rate for Payer: Priority Health Cigna Priority Health	$17.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$23.39

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION

Facility

$21.65

Service Code	NDC 67850007100
Hospital Charge Code	8527
Hospital Revenue Code	250
Min. Negotiated Rate	$8.66
Max. Negotiated Rate	$21.65
Rate for Payer: Aetna Commercial	$19.48
Rate for Payer: Aetna Medicare	$10.82
Rate for Payer: ASR ASR	$21.00
Rate for Payer: ASR Commercial	$21.00
Rate for Payer: BCBS Complete	$8.66
Rate for Payer: BCBS Trust/PPO	$17.73
Rate for Payer: BCN Commercial	$16.79
Rate for Payer: Cash Price	$17.32
Rate for Payer: Cofinity Commercial	$20.35
Rate for Payer: Encore Health Key Benefits Commercial	$17.32
Rate for Payer: Healthscope Commercial	$21.65
Rate for Payer: Healthscope Whirlpool	$21.00
Rate for Payer: Mclaren Commercial	$19.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.40
Rate for Payer: Nomi Health Commercial	$17.75
Rate for Payer: Priority Health Cigna Priority Health	$14.07
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18.97
Rate for Payer: Priority Health Narrow Network	$15.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$19.05

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION

Facility

$21.65

Service Code	NDC 67850007100
Hospital Charge Code	8527
Hospital Revenue Code	250
Min. Negotiated Rate	$14.07
Max. Negotiated Rate	$21.65
Rate for Payer: Aetna Commercial	$19.48
Rate for Payer: ASR ASR	$21.00
Rate for Payer: ASR Commercial	$21.00
Rate for Payer: BCBS Trust/PPO	$17.64
Rate for Payer: BCN Commercial	$16.79
Rate for Payer: Cash Price	$17.32
Rate for Payer: Cofinity Commercial	$20.35
Rate for Payer: Encore Health Key Benefits Commercial	$17.32
Rate for Payer: Healthscope Commercial	$21.65
Rate for Payer: Healthscope Whirlpool	$21.00
Rate for Payer: Mclaren Commercial	$19.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.40
Rate for Payer: Nomi Health Commercial	$17.75
Rate for Payer: Priority Health Cigna Priority Health	$14.07
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$19.05

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION

Facility

$17.66

Service Code	NDC 70756060525
Hospital Charge Code	8527
Hospital Revenue Code	250
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$17.66
Rate for Payer: Aetna Commercial	$15.89
Rate for Payer: Aetna Medicare	$8.83
Rate for Payer: ASR ASR	$17.13
Rate for Payer: ASR Commercial	$17.13
Rate for Payer: BCBS Complete	$7.06
Rate for Payer: BCBS Trust/PPO	$14.46
Rate for Payer: BCN Commercial	$13.69
Rate for Payer: Cash Price	$14.13
Rate for Payer: Cofinity Commercial	$16.60
Rate for Payer: Encore Health Key Benefits Commercial	$14.13
Rate for Payer: Healthscope Commercial	$17.66
Rate for Payer: Healthscope Whirlpool	$17.13
Rate for Payer: Mclaren Commercial	$15.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.01
Rate for Payer: Nomi Health Commercial	$14.48
Rate for Payer: Priority Health Cigna Priority Health	$11.48
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15.47
Rate for Payer: Priority Health Narrow Network	$12.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$15.54

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION

Facility

$113.39

Service Code	NDC 00409114405
Hospital Charge Code	8527
Hospital Revenue Code	250
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$113.39
Rate for Payer: Aetna Commercial	$102.05
Rate for Payer: Aetna Medicare	$56.70
Rate for Payer: ASR ASR	$109.99
Rate for Payer: ASR Commercial	$109.99
Rate for Payer: BCBS Complete	$45.36
Rate for Payer: BCBS Trust/PPO	$92.86
Rate for Payer: BCN Commercial	$87.91
Rate for Payer: Cash Price	$90.72
Rate for Payer: Cofinity Commercial	$106.59
Rate for Payer: Encore Health Key Benefits Commercial	$90.71
Rate for Payer: Healthscope Commercial	$113.39
Rate for Payer: Healthscope Whirlpool	$109.99
Rate for Payer: Mclaren Commercial	$102.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$96.38
Rate for Payer: Nomi Health Commercial	$92.98
Rate for Payer: Priority Health Cigna Priority Health	$73.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$99.35
Rate for Payer: Priority Health Narrow Network	$79.49
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$99.78

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION

Facility

$26.58

Service Code	NDC 67850007125
Hospital Charge Code	8527
Hospital Revenue Code	250
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$26.58
Rate for Payer: Aetna Commercial	$23.92
Rate for Payer: Aetna Medicare	$13.29
Rate for Payer: ASR ASR	$25.78
Rate for Payer: ASR Commercial	$25.78
Rate for Payer: BCBS Complete	$10.63
Rate for Payer: BCBS Trust/PPO	$21.77
Rate for Payer: BCN Commercial	$20.61
Rate for Payer: Cash Price	$21.26
Rate for Payer: Cofinity Commercial	$24.99
Rate for Payer: Encore Health Key Benefits Commercial	$21.26
Rate for Payer: Healthscope Commercial	$26.58
Rate for Payer: Healthscope Whirlpool	$25.78
Rate for Payer: Mclaren Commercial	$23.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.59
Rate for Payer: Nomi Health Commercial	$21.80
Rate for Payer: Priority Health Cigna Priority Health	$17.28
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$23.29
Rate for Payer: Priority Health Narrow Network	$18.63
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$23.39

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION

Facility

$21.48

Service Code	NDC 70710164301
Hospital Charge Code	8527
Hospital Revenue Code	250
Min. Negotiated Rate	$13.96
Max. Negotiated Rate	$21.48
Rate for Payer: Aetna Commercial	$19.33
Rate for Payer: ASR ASR	$20.84
Rate for Payer: ASR Commercial	$20.84
Rate for Payer: BCBS Trust/PPO	$17.50
Rate for Payer: BCN Commercial	$16.65
Rate for Payer: Cash Price	$17.18
Rate for Payer: Cofinity Commercial	$20.19
Rate for Payer: Encore Health Key Benefits Commercial	$17.18
Rate for Payer: Healthscope Commercial	$21.48
Rate for Payer: Healthscope Whirlpool	$20.84
Rate for Payer: Mclaren Commercial	$19.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.26
Rate for Payer: Nomi Health Commercial	$17.61
Rate for Payer: Priority Health Cigna Priority Health	$13.96
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.90

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION

Facility

$18.26

Service Code	NDC 70756060582
Hospital Charge Code	8527
Hospital Revenue Code	250
Min. Negotiated Rate	$11.87
Max. Negotiated Rate	$18.26
Rate for Payer: Aetna Commercial	$16.43
Rate for Payer: ASR ASR	$17.71
Rate for Payer: ASR Commercial	$17.71
Rate for Payer: BCBS Trust/PPO	$14.88
Rate for Payer: BCN Commercial	$14.16
Rate for Payer: Cash Price	$14.61
Rate for Payer: Cofinity Commercial	$17.16
Rate for Payer: Encore Health Key Benefits Commercial	$14.61
Rate for Payer: Healthscope Commercial	$18.26
Rate for Payer: Healthscope Whirlpool	$17.71
Rate for Payer: Mclaren Commercial	$16.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.52
Rate for Payer: Nomi Health Commercial	$14.97
Rate for Payer: Priority Health Cigna Priority Health	$11.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.07

Know your out-of-pocket cost for care.

All Charges