|
VERAPAMIL/2.5MG/1ML
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
60634151
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
|
|
VERAPAMIL/2.5MG/1ML
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
60634152
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare Advantage |
$3.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.31
|
| Rate for Payer: Cigna Commercial |
$6.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.69
|
| Rate for Payer: Oxford Commercial |
$6.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.50
|
|
|
VERAPAMIL/2.5MG/1ML
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
60634152
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
|
|
VERAPAMIL/2.5MG/1ML
|
Facility
|
OP
|
$18.00
|
|
| Hospital Charge Code |
60634150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Medicare Advantage |
$5.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.59
|
| Rate for Payer: Cigna Commercial |
$9.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.34
|
| Rate for Payer: Oxford Commercial |
$9.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.00
|
|
|
VERAPAMIL/2.5MG/1ML
|
Facility
|
IP
|
$18.00
|
|
| Hospital Charge Code |
60634150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.70
|
|
|
VERAPAMIL 40 MG TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 591040401
|
| Hospital Charge Code |
60627616
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.20
|
| Rate for Payer: Aetna Medicare Advantage |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.02
|
| Rate for Payer: Cigna Commercial |
$2.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.52
|
| Rate for Payer: Oxford Commercial |
$2.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.00
|
|
|
VERAPAMIL 40 MG TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 591040401
|
| Hospital Charge Code |
60627616
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
VERAPAMIL 5 MG/2ML INJ
|
Facility
|
IP
|
$158.75
|
|
| Hospital Charge Code |
6005649R
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.81 |
| Max. Negotiated Rate |
$23.81 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.81
|
|
|
VERAPAMIL 5 MG/2ML INJ
|
Facility
|
IP
|
$212.73
|
|
|
Service Code
|
NDC 409114405
|
| Hospital Charge Code |
6005649
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.91 |
| Max. Negotiated Rate |
$31.91 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.91
|
|
|
VERAPAMIL 5 MG/2ML INJ
|
Facility
|
OP
|
$158.75
|
|
| Hospital Charge Code |
6005649R
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$79.38 |
| Rate for Payer: Aetna Commercial |
$47.62
|
| Rate for Payer: Aetna Medicare Advantage |
$47.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$40.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$40.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$40.48
|
| Rate for Payer: Cigna Commercial |
$79.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.64
|
| Rate for Payer: Oxford Commercial |
$79.38
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$79.38
|
|
|
VERAPAMIL 5 MG/2ML INJ
|
Facility
|
OP
|
$212.73
|
|
|
Service Code
|
NDC 409114405
|
| Hospital Charge Code |
6005649
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.65 |
| Max. Negotiated Rate |
$106.36 |
| Rate for Payer: Aetna Commercial |
$63.82
|
| Rate for Payer: Aetna Medicare Advantage |
$63.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.25
|
| Rate for Payer: Cigna Commercial |
$106.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.65
|
| Rate for Payer: Oxford Commercial |
$106.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$31.91
|
| Rate for Payer: UnitedHealthcare Commercial |
$106.36
|
|
|
VERAPAMIL 80 MG TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 904292061
|
| Hospital Charge Code |
60627617
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
VERAPAMIL 80 MG TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 904292061
|
| Hospital Charge Code |
60627617
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.20
|
| Rate for Payer: Aetna Medicare Advantage |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.02
|
| Rate for Payer: Cigna Commercial |
$2.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.52
|
| Rate for Payer: Oxford Commercial |
$2.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.00
|
|
|
VERAPAMIL ER 120MG CAP
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 378632001
|
| Hospital Charge Code |
6063943302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
|
|
VERAPAMIL ER 120MG CAP
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
NDC 378632001
|
| Hospital Charge Code |
6063943302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare Advantage |
$3.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.31
|
| Rate for Payer: Cigna Commercial |
$6.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.69
|
| Rate for Payer: Oxford Commercial |
$6.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.50
|
|
|
VERAPAMIL TAB 40MG
|
Facility
|
IP
|
$1.95
|
|
| Hospital Charge Code |
6023436
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.29
|
|
|
VERAPAMIL TAB 40MG
|
Facility
|
OP
|
$1.95
|
|
| Hospital Charge Code |
6023436
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna Commercial |
$0.59
|
| Rate for Payer: Aetna Medicare Advantage |
$0.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.25
|
| Rate for Payer: Oxford Commercial |
$0.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.98
|
|
|
VERAPAMIL TAB 80MG
|
Facility
|
IP
|
$1.95
|
|
| Hospital Charge Code |
6023006
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.29
|
|
|
VERAPAMIL TAB 80MG
|
Facility
|
OP
|
$1.95
|
|
| Hospital Charge Code |
6023006
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna Commercial |
$0.59
|
| Rate for Payer: Aetna Medicare Advantage |
$0.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.25
|
| Rate for Payer: Oxford Commercial |
$0.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.98
|
|
|
VERAPAMIL TAB CR 180MG
|
Facility
|
IP
|
$8.35
|
|
| Hospital Charge Code |
60628735
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.25
|
|
|
VERAPAMIL TAB CR 180MG
|
Facility
|
OP
|
$8.35
|
|
| Hospital Charge Code |
60628735
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.13
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.09
|
| Rate for Payer: Oxford Commercial |
$4.17
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$4.17
|
|
|
VERAPAMIL TAB CR 240MG
|
Facility
|
IP
|
$10.25
|
|
| Hospital Charge Code |
60628736
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.54
|
|
|
VERAPAMIL TAB CR 240MG
|
Facility
|
OP
|
$10.25
|
|
| Hospital Charge Code |
60628736
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: Aetna Medicare Advantage |
$3.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2.61
|
| Rate for Payer: Cigna Commercial |
$5.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.33
|
| Rate for Payer: Oxford Commercial |
$5.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.12
|
|
|
VERAPAMIL TAB SR 240MG
|
Facility
|
IP
|
$3.85
|
|
| Hospital Charge Code |
6025068
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.58
|
|
|
VERAPAMIL TAB SR 240MG
|
Facility
|
OP
|
$3.85
|
|
| Hospital Charge Code |
6025068
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: Aetna Medicare Advantage |
$1.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.98
|
| Rate for Payer: Cigna Commercial |
$1.93
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.50
|
| Rate for Payer: Oxford Commercial |
$1.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.93
|
|