|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$37.25
|
|
|
Service Code
|
NDC 00409401101
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.21 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: ASR ASR |
$36.13
|
| Rate for Payer: ASR Commercial |
$36.13
|
| Rate for Payer: BCBS Trust/PPO |
$30.36
|
| Rate for Payer: BCN Commercial |
$28.88
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cofinity Commercial |
$35.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Healthscope Whirlpool |
$36.13
|
| Rate for Payer: Mclaren Commercial |
$33.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.66
|
| Rate for Payer: Nomi Health Commercial |
$30.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.78
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.66
|
|
|
Service Code
|
NDC 70756060525
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$17.66 |
| Rate for Payer: Aetna Commercial |
$15.89
|
| Rate for Payer: ASR ASR |
$17.13
|
| Rate for Payer: ASR Commercial |
$17.13
|
| Rate for Payer: BCBS Trust/PPO |
$14.39
|
| 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: UHC All Payor (Choice/PPO) + Core |
$15.54
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.48
|
|
|
Service Code
|
NDC 70710164301
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna Commercial |
$19.33
|
| Rate for Payer: Aetna Medicare |
$10.74
|
| Rate for Payer: ASR ASR |
$20.84
|
| Rate for Payer: ASR Commercial |
$20.84
|
| Rate for Payer: BCBS Complete |
$8.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.59
|
| 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: Priority Health HMO/PPO/Tiered Network |
$18.82
|
| Rate for Payer: Priority Health Narrow Network |
$15.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.90
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$37.25
|
|
|
Service Code
|
NDC 00409401101
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: ASR ASR |
$36.13
|
| Rate for Payer: ASR Commercial |
$36.13
|
| Rate for Payer: BCBS Complete |
$14.90
|
| Rate for Payer: BCBS Trust/PPO |
$30.50
|
| Rate for Payer: BCN Commercial |
$28.88
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cofinity Commercial |
$35.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Healthscope Whirlpool |
$36.13
|
| Rate for Payer: Mclaren Commercial |
$33.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.66
|
| Rate for Payer: Nomi Health Commercial |
$30.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.64
|
| Rate for Payer: Priority Health Narrow Network |
$26.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.78
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.48
|
|
|
Service Code
|
NDC 70710164307
|
| 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
|
OP
|
$21.48
|
|
|
Service Code
|
NDC 70710164307
|
| Hospital Charge Code |
8527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna Commercial |
$19.33
|
| Rate for Payer: Aetna Medicare |
$10.74
|
| Rate for Payer: ASR ASR |
$20.84
|
| Rate for Payer: ASR Commercial |
$20.84
|
| Rate for Payer: BCBS Complete |
$8.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.59
|
| 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: Priority Health HMO/PPO/Tiered Network |
$18.82
|
| Rate for Payer: Priority Health Narrow Network |
$15.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.90
|
|
|
VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
OP
|
$12.16
|
|
|
Service Code
|
NDC 51079091701
|
| Hospital Charge Code |
25238
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$12.16 |
| Rate for Payer: Aetna Commercial |
$10.94
|
| Rate for Payer: Aetna Medicare |
$6.08
|
| Rate for Payer: ASR ASR |
$11.80
|
| Rate for Payer: ASR Commercial |
$11.80
|
| Rate for Payer: BCBS Complete |
$4.86
|
| Rate for Payer: BCBS Trust/PPO |
$9.96
|
| Rate for Payer: BCN Commercial |
$9.43
|
| Rate for Payer: Cash Price |
$9.73
|
| Rate for Payer: Cofinity Commercial |
$11.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.73
|
| Rate for Payer: Healthscope Commercial |
$12.16
|
| Rate for Payer: Healthscope Whirlpool |
$11.80
|
| Rate for Payer: Mclaren Commercial |
$10.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.34
|
| Rate for Payer: Nomi Health Commercial |
$9.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.65
|
| Rate for Payer: Priority Health Narrow Network |
$8.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.70
|
|
|
VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$12.16
|
|
|
Service Code
|
NDC 51079091701
|
| Hospital Charge Code |
25238
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$12.16 |
| Rate for Payer: Aetna Commercial |
$10.94
|
| Rate for Payer: ASR ASR |
$11.80
|
| Rate for Payer: ASR Commercial |
$11.80
|
| Rate for Payer: BCBS Trust/PPO |
$9.91
|
| Rate for Payer: BCN Commercial |
$9.43
|
| Rate for Payer: Cash Price |
$9.73
|
| Rate for Payer: Cofinity Commercial |
$11.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.73
|
| Rate for Payer: Healthscope Commercial |
$12.16
|
| Rate for Payer: Healthscope Whirlpool |
$11.80
|
| Rate for Payer: Mclaren Commercial |
$10.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.34
|
| Rate for Payer: Nomi Health Commercial |
$9.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.70
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$200.45
|
|
|
Service Code
|
NDC 68462029201
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.18 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna Commercial |
$180.41
|
| Rate for Payer: Aetna Medicare |
$100.22
|
| Rate for Payer: ASR ASR |
$194.44
|
| Rate for Payer: ASR Commercial |
$194.44
|
| Rate for Payer: BCBS Complete |
$80.18
|
| Rate for Payer: BCBS Trust/PPO |
$164.15
|
| Rate for Payer: BCN Commercial |
$155.41
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$188.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$200.45
|
| Rate for Payer: Healthscope Whirlpool |
$194.44
|
| Rate for Payer: Mclaren Commercial |
$180.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Nomi Health Commercial |
$164.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.63
|
| Rate for Payer: Priority Health Narrow Network |
$140.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.40
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$5.25
|
|
|
Service Code
|
NDC 60687049311
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna Commercial |
$4.72
|
| Rate for Payer: ASR ASR |
$5.09
|
| Rate for Payer: ASR Commercial |
$5.09
|
| Rate for Payer: BCBS Trust/PPO |
$4.28
|
| Rate for Payer: BCN Commercial |
$4.07
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$4.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$5.25
|
| Rate for Payer: Healthscope Whirlpool |
$5.09
|
| Rate for Payer: Mclaren Commercial |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.46
|
| Rate for Payer: Nomi Health Commercial |
$4.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.62
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$200.45
|
|
|
Service Code
|
NDC 68462029201
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.29 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna Commercial |
$180.41
|
| Rate for Payer: ASR ASR |
$194.44
|
| Rate for Payer: ASR Commercial |
$194.44
|
| Rate for Payer: BCBS Trust/PPO |
$163.35
|
| Rate for Payer: BCN Commercial |
$155.41
|
| Rate for Payer: Cash Price |
$160.36
|
| Rate for Payer: Cofinity Commercial |
$188.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.36
|
| Rate for Payer: Healthscope Commercial |
$200.45
|
| Rate for Payer: Healthscope Whirlpool |
$194.44
|
| Rate for Payer: Mclaren Commercial |
$180.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.38
|
| Rate for Payer: Nomi Health Commercial |
$164.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.40
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$524.64
|
|
|
Service Code
|
NDC 60687049301
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.86 |
| Max. Negotiated Rate |
$524.64 |
| Rate for Payer: Aetna Commercial |
$472.18
|
| Rate for Payer: Aetna Medicare |
$262.32
|
| Rate for Payer: ASR ASR |
$508.90
|
| Rate for Payer: ASR Commercial |
$508.90
|
| Rate for Payer: BCBS Complete |
$209.86
|
| Rate for Payer: BCBS Trust/PPO |
$429.63
|
| Rate for Payer: BCN Commercial |
$406.75
|
| Rate for Payer: Cash Price |
$419.71
|
| Rate for Payer: Cofinity Commercial |
$493.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.71
|
| Rate for Payer: Healthscope Commercial |
$524.64
|
| Rate for Payer: Healthscope Whirlpool |
$508.90
|
| Rate for Payer: Mclaren Commercial |
$472.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.94
|
| Rate for Payer: Nomi Health Commercial |
$430.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$459.69
|
| Rate for Payer: Priority Health Narrow Network |
$367.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.68
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$5.25
|
|
|
Service Code
|
NDC 60687049311
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna Commercial |
$4.72
|
| Rate for Payer: Aetna Medicare |
$2.62
|
| Rate for Payer: ASR ASR |
$5.09
|
| Rate for Payer: ASR Commercial |
$5.09
|
| Rate for Payer: BCBS Complete |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.07
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$4.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.20
|
| Rate for Payer: Healthscope Commercial |
$5.25
|
| Rate for Payer: Healthscope Whirlpool |
$5.09
|
| Rate for Payer: Mclaren Commercial |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.46
|
| Rate for Payer: Nomi Health Commercial |
$4.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.60
|
| Rate for Payer: Priority Health Narrow Network |
$3.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.62
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$524.64
|
|
|
Service Code
|
NDC 60687049301
|
| Hospital Charge Code |
11639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$341.02 |
| Max. Negotiated Rate |
$524.64 |
| Rate for Payer: Aetna Commercial |
$472.18
|
| Rate for Payer: ASR ASR |
$508.90
|
| Rate for Payer: ASR Commercial |
$508.90
|
| Rate for Payer: BCBS Trust/PPO |
$427.53
|
| Rate for Payer: BCN Commercial |
$406.75
|
| Rate for Payer: Cash Price |
$419.71
|
| Rate for Payer: Cofinity Commercial |
$493.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.71
|
| Rate for Payer: Healthscope Commercial |
$524.64
|
| Rate for Payer: Healthscope Whirlpool |
$508.90
|
| Rate for Payer: Mclaren Commercial |
$472.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$445.94
|
| Rate for Payer: Nomi Health Commercial |
$430.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.68
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$432.40
|
|
|
Service Code
|
NDC 68462029301
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.06 |
| Max. Negotiated Rate |
$432.40 |
| Rate for Payer: Aetna Commercial |
$389.16
|
| Rate for Payer: ASR ASR |
$419.43
|
| Rate for Payer: ASR Commercial |
$419.43
|
| Rate for Payer: BCBS Trust/PPO |
$352.36
|
| Rate for Payer: BCN Commercial |
$335.24
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Commercial |
$406.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$432.40
|
| Rate for Payer: Healthscope Whirlpool |
$419.43
|
| Rate for Payer: Mclaren Commercial |
$389.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Nomi Health Commercial |
$354.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$380.51
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$561.60
|
|
|
Service Code
|
NDC 60687050401
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.64 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna Commercial |
$505.44
|
| Rate for Payer: Aetna Medicare |
$280.80
|
| Rate for Payer: ASR ASR |
$544.75
|
| Rate for Payer: ASR Commercial |
$544.75
|
| Rate for Payer: BCBS Complete |
$224.64
|
| Rate for Payer: BCBS Trust/PPO |
$459.89
|
| Rate for Payer: BCN Commercial |
$435.41
|
| Rate for Payer: Cash Price |
$449.28
|
| Rate for Payer: Cofinity Commercial |
$527.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.28
|
| Rate for Payer: Healthscope Commercial |
$561.60
|
| Rate for Payer: Healthscope Whirlpool |
$544.75
|
| Rate for Payer: Mclaren Commercial |
$505.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.36
|
| Rate for Payer: Nomi Health Commercial |
$460.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$492.07
|
| Rate for Payer: Priority Health Narrow Network |
$393.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.21
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$561.60
|
|
|
Service Code
|
NDC 60687050401
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$365.04 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna Commercial |
$505.44
|
| Rate for Payer: ASR ASR |
$544.75
|
| Rate for Payer: ASR Commercial |
$544.75
|
| Rate for Payer: BCBS Trust/PPO |
$457.65
|
| Rate for Payer: BCN Commercial |
$435.41
|
| Rate for Payer: Cash Price |
$449.28
|
| Rate for Payer: Cofinity Commercial |
$527.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.28
|
| Rate for Payer: Healthscope Commercial |
$561.60
|
| Rate for Payer: Healthscope Whirlpool |
$544.75
|
| Rate for Payer: Mclaren Commercial |
$505.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.36
|
| Rate for Payer: Nomi Health Commercial |
$460.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.21
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$5.62
|
|
|
Service Code
|
NDC 60687050411
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$5.06
|
| Rate for Payer: Aetna Medicare |
$2.81
|
| Rate for Payer: ASR ASR |
$5.45
|
| Rate for Payer: ASR Commercial |
$5.45
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: BCBS Trust/PPO |
$4.60
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cofinity Commercial |
$5.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Healthscope Whirlpool |
$5.45
|
| Rate for Payer: Mclaren Commercial |
$5.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.78
|
| Rate for Payer: Nomi Health Commercial |
$4.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.92
|
| Rate for Payer: Priority Health Narrow Network |
$3.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.95
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$432.40
|
|
|
Service Code
|
NDC 68462029301
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.96 |
| Max. Negotiated Rate |
$432.40 |
| Rate for Payer: Aetna Commercial |
$389.16
|
| Rate for Payer: Aetna Medicare |
$216.20
|
| Rate for Payer: ASR ASR |
$419.43
|
| Rate for Payer: ASR Commercial |
$419.43
|
| Rate for Payer: BCBS Complete |
$172.96
|
| Rate for Payer: BCBS Trust/PPO |
$354.09
|
| Rate for Payer: BCN Commercial |
$335.24
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Commercial |
$406.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$432.40
|
| Rate for Payer: Healthscope Whirlpool |
$419.43
|
| Rate for Payer: Mclaren Commercial |
$389.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Nomi Health Commercial |
$354.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$378.87
|
| Rate for Payer: Priority Health Narrow Network |
$303.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$380.51
|
|
|
VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$5.62
|
|
|
Service Code
|
NDC 60687050411
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$5.06
|
| Rate for Payer: ASR ASR |
$5.45
|
| Rate for Payer: ASR Commercial |
$5.45
|
| Rate for Payer: BCBS Trust/PPO |
$4.58
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cofinity Commercial |
$5.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Healthscope Whirlpool |
$5.45
|
| Rate for Payer: Mclaren Commercial |
$5.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.78
|
| Rate for Payer: Nomi Health Commercial |
$4.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.95
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
IP
|
$527.03
|
|
|
Service Code
|
NDC 60505477303
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$342.57 |
| Max. Negotiated Rate |
$527.03 |
| Rate for Payer: Aetna Commercial |
$474.33
|
| Rate for Payer: ASR ASR |
$511.22
|
| Rate for Payer: ASR Commercial |
$511.22
|
| Rate for Payer: BCBS Trust/PPO |
$429.48
|
| Rate for Payer: BCN Commercial |
$408.61
|
| Rate for Payer: Cash Price |
$421.62
|
| Rate for Payer: Cofinity Commercial |
$495.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.62
|
| Rate for Payer: Healthscope Commercial |
$527.03
|
| Rate for Payer: Healthscope Whirlpool |
$511.22
|
| Rate for Payer: Mclaren Commercial |
$474.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.98
|
| Rate for Payer: Nomi Health Commercial |
$432.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$463.79
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
OP
|
$1,254.74
|
|
|
Service Code
|
NDC 00456112030
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$501.90 |
| Max. Negotiated Rate |
$1,254.74 |
| Rate for Payer: Aetna Commercial |
$1,129.27
|
| Rate for Payer: Aetna Medicare |
$627.37
|
| Rate for Payer: ASR ASR |
$1,217.10
|
| Rate for Payer: ASR Commercial |
$1,217.10
|
| Rate for Payer: BCBS Complete |
$501.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,027.51
|
| Rate for Payer: BCN Commercial |
$972.80
|
| Rate for Payer: Cash Price |
$1,003.80
|
| Rate for Payer: Cofinity Commercial |
$1,179.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,003.79
|
| Rate for Payer: Healthscope Commercial |
$1,254.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,217.10
|
| Rate for Payer: Mclaren Commercial |
$1,129.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,066.53
|
| Rate for Payer: Nomi Health Commercial |
$1,028.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.40
|
| Rate for Payer: Priority Health Narrow Network |
$879.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,104.17
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
IP
|
$1,254.74
|
|
|
Service Code
|
NDC 00456112030
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$815.58 |
| Max. Negotiated Rate |
$1,254.74 |
| Rate for Payer: Aetna Commercial |
$1,129.27
|
| Rate for Payer: ASR ASR |
$1,217.10
|
| Rate for Payer: ASR Commercial |
$1,217.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,022.49
|
| Rate for Payer: BCN Commercial |
$972.80
|
| Rate for Payer: Cash Price |
$1,003.80
|
| Rate for Payer: Cofinity Commercial |
$1,179.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,003.79
|
| Rate for Payer: Healthscope Commercial |
$1,254.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,217.10
|
| Rate for Payer: Mclaren Commercial |
$1,129.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,066.53
|
| Rate for Payer: Nomi Health Commercial |
$1,028.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,104.17
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
IP
|
$154.51
|
|
|
Service Code
|
NDC 60505437303
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.43 |
| Max. Negotiated Rate |
$154.51 |
| Rate for Payer: Aetna Commercial |
$139.06
|
| Rate for Payer: ASR ASR |
$149.87
|
| Rate for Payer: ASR Commercial |
$149.87
|
| Rate for Payer: BCBS Trust/PPO |
$125.91
|
| Rate for Payer: BCN Commercial |
$119.79
|
| Rate for Payer: Cash Price |
$123.61
|
| Rate for Payer: Cofinity Commercial |
$145.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.61
|
| Rate for Payer: Healthscope Commercial |
$154.51
|
| Rate for Payer: Healthscope Whirlpool |
$149.87
|
| Rate for Payer: Mclaren Commercial |
$139.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.33
|
| Rate for Payer: Nomi Health Commercial |
$126.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.97
|
|
|
VILAZODONE 20 MG TABLET
|
Facility
|
OP
|
$154.51
|
|
|
Service Code
|
NDC 60505437303
|
| Hospital Charge Code |
152700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.80 |
| Max. Negotiated Rate |
$154.51 |
| Rate for Payer: Aetna Commercial |
$139.06
|
| Rate for Payer: Aetna Medicare |
$77.25
|
| Rate for Payer: ASR ASR |
$149.87
|
| Rate for Payer: ASR Commercial |
$149.87
|
| Rate for Payer: BCBS Complete |
$61.80
|
| Rate for Payer: BCBS Trust/PPO |
$126.53
|
| Rate for Payer: BCN Commercial |
$119.79
|
| Rate for Payer: Cash Price |
$123.61
|
| Rate for Payer: Cofinity Commercial |
$145.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.61
|
| Rate for Payer: Healthscope Commercial |
$154.51
|
| Rate for Payer: Healthscope Whirlpool |
$149.87
|
| Rate for Payer: Mclaren Commercial |
$139.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.33
|
| Rate for Payer: Nomi Health Commercial |
$126.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.38
|
| Rate for Payer: Priority Health Narrow Network |
$108.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.97
|
|
