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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

OP

$13.68

Service Code	NDC 67457-475-20
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$10.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.21
Rate for Payer: Aetna of CA Government/Medicare	$8.21
Rate for Payer: Cash Price	$7.52
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.94
Rate for Payer: Health Smart Auto/Commercial	$8.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.21
Rate for Payer: LLUH Dept of Risk Management WC	$7.52
Rate for Payer: Multiplan Commercial	$10.26

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

OP

$10.80

Service Code	NDC 55150-236-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.48
Rate for Payer: Aetna of CA Government/Medicare	$6.48
Rate for Payer: Cash Price	$5.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.64
Rate for Payer: Health Smart Auto/Commercial	$6.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.48
Rate for Payer: LLUH Dept of Risk Management WC	$5.94
Rate for Payer: Multiplan Commercial	$8.10

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

IP

$10.80

Service Code	NDC 55150-236-01
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$8.64
Rate for Payer: Cash Price	$5.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.64
Rate for Payer: Health Smart Auto/Commercial	$6.48
Rate for Payer: LLUH Dept of Risk Management WC	$5.94
Rate for Payer: Multiplan Commercial	$8.10

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

IP

$20.40

Service Code	NDC 47335-932-44
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$11.22
Max. Negotiated Rate	$16.32
Rate for Payer: Cash Price	$11.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.32
Rate for Payer: Health Smart Auto/Commercial	$12.24
Rate for Payer: LLUH Dept of Risk Management WC	$11.22
Rate for Payer: Multiplan Commercial	$15.30

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

IP

$13.68

Service Code	NDC 67457-475-20
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$10.94
Rate for Payer: Cash Price	$7.52
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.94
Rate for Payer: Health Smart Auto/Commercial	$8.21
Rate for Payer: LLUH Dept of Risk Management WC	$7.52
Rate for Payer: Multiplan Commercial	$10.26

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

IP

$14.46

Service Code	NDC 63323-782-20
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$11.57
Rate for Payer: Cash Price	$7.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.57
Rate for Payer: Health Smart Auto/Commercial	$8.68
Rate for Payer: LLUH Dept of Risk Management WC	$7.95
Rate for Payer: Multiplan Commercial	$10.85

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

OP

$13.68

Service Code	NDC 67457-475-00
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$10.94
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.21
Rate for Payer: Aetna of CA Government/Medicare	$8.21
Rate for Payer: Cash Price	$7.52
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.94
Rate for Payer: Health Smart Auto/Commercial	$8.21
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.21
Rate for Payer: LLUH Dept of Risk Management WC	$7.52
Rate for Payer: Multiplan Commercial	$10.26

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

IP

$20.40

Service Code	NDC 47335-932-40
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$11.22
Max. Negotiated Rate	$16.32
Rate for Payer: Cash Price	$11.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.32
Rate for Payer: Health Smart Auto/Commercial	$12.24
Rate for Payer: LLUH Dept of Risk Management WC	$11.22
Rate for Payer: Multiplan Commercial	$15.30

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

OP

$20.40

Service Code	NDC 47335-932-40
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$11.22
Max. Negotiated Rate	$16.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.24
Rate for Payer: Aetna of CA Government/Medicare	$12.24
Rate for Payer: Cash Price	$11.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.32
Rate for Payer: Health Smart Auto/Commercial	$12.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.24
Rate for Payer: LLUH Dept of Risk Management WC	$11.22
Rate for Payer: Multiplan Commercial	$15.30

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

IP

$13.68

Service Code	NDC 67457-475-00
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$10.94
Rate for Payer: Cash Price	$7.52
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$10.94
Rate for Payer: Health Smart Auto/Commercial	$8.21
Rate for Payer: LLUH Dept of Risk Management WC	$7.52
Rate for Payer: Multiplan Commercial	$10.26

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

OP

$20.40

Service Code	NDC 47335-932-44
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$11.22
Max. Negotiated Rate	$16.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.24
Rate for Payer: Aetna of CA Government/Medicare	$12.24
Rate for Payer: Cash Price	$11.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.32
Rate for Payer: Health Smart Auto/Commercial	$12.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.24
Rate for Payer: LLUH Dept of Risk Management WC	$11.22
Rate for Payer: Multiplan Commercial	$15.30

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

IP

$10.80

Service Code	NDC 55150-236-20
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$8.64
Rate for Payer: Cash Price	$5.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.64
Rate for Payer: Health Smart Auto/Commercial	$6.48
Rate for Payer: LLUH Dept of Risk Management WC	$5.94
Rate for Payer: Multiplan Commercial	$8.10

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

OP

$10.80

Service Code	NDC 55150-236-20
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$6.48
Rate for Payer: Aetna of CA Government/Medicare	$6.48
Rate for Payer: Cash Price	$5.94
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$8.64
Rate for Payer: Health Smart Auto/Commercial	$6.48
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$6.48
Rate for Payer: LLUH Dept of Risk Management WC	$5.94
Rate for Payer: Multiplan Commercial	$8.10

VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION [11635]

Facility

OP

$14.46

Service Code	NDC 63323-782-20
Hospital Charge Code	901700004
Hospital Revenue Code	250
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$11.57
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.68
Rate for Payer: Aetna of CA Government/Medicare	$8.68
Rate for Payer: Cash Price	$7.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.57
Rate for Payer: Health Smart Auto/Commercial	$8.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.68
Rate for Payer: LLUH Dept of Risk Management WC	$7.95
Rate for Payer: Multiplan Commercial	$10.85

VENETOCLAX 100 MG TABLET [214191]

Facility

IP

$156.21

Service Code	NDC 0074-0576-22
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$85.92
Max. Negotiated Rate	$124.97
Rate for Payer: Cash Price	$85.91
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$124.97
Rate for Payer: Health Smart Auto/Commercial	$93.73
Rate for Payer: LLUH Dept of Risk Management WC	$85.92
Rate for Payer: Multiplan Commercial	$117.16

VENETOCLAX 100 MG TABLET [214191]

Facility

OP

$156.21

Service Code	NDC 0074-0576-22
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$85.92
Max. Negotiated Rate	$124.97
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$93.73
Rate for Payer: Aetna of CA Government/Medicare	$93.73
Rate for Payer: Cash Price	$85.91
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$124.97
Rate for Payer: Health Smart Auto/Commercial	$93.73
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$93.73
Rate for Payer: LLUH Dept of Risk Management WC	$85.92
Rate for Payer: Multiplan Commercial	$117.16

VENLAFAXINE 100 MG TABLET [12205]

Facility

OP

$0.46

Service Code	NDC 68382-101-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.37
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.28
Rate for Payer: Aetna of CA Government/Medicare	$0.28
Rate for Payer: Cash Price	$0.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.37
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Commercial	$0.35

VENLAFAXINE 100 MG TABLET [12205]

Facility

IP

$0.46

Service Code	NDC 68382-101-01
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.37
Rate for Payer: Cash Price	$0.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.37
Rate for Payer: Health Smart Auto/Commercial	$0.28
Rate for Payer: LLUH Dept of Risk Management WC	$0.25
Rate for Payer: Multiplan Commercial	$0.35

VENLAFAXINE 25 MG TABLET [12203]

Facility

IP

$1.26

Service Code	NDC 68084-896-25
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.01
Rate for Payer: Cash Price	$0.69
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.01
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: Multiplan Commercial	$0.95

VENLAFAXINE 25 MG TABLET [12203]

Facility

OP

$1.26

Service Code	NDC 68084-896-25
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.76
Rate for Payer: Aetna of CA Government/Medicare	$0.76
Rate for Payer: Cash Price	$0.69
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.01
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.76
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: Multiplan Commercial	$0.95

VENLAFAXINE 25 MG TABLET [12203]

Facility

IP

$1.26

Service Code	NDC 68084-896-95
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.01
Rate for Payer: Cash Price	$0.69
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.01
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: Multiplan Commercial	$0.95

VENLAFAXINE 25 MG TABLET [12203]

Facility

OP

$1.26

Service Code	NDC 68084-896-95
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.01
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.76
Rate for Payer: Aetna of CA Government/Medicare	$0.76
Rate for Payer: Cash Price	$0.69
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$1.01
Rate for Payer: Health Smart Auto/Commercial	$0.76
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.76
Rate for Payer: LLUH Dept of Risk Management WC	$0.69
Rate for Payer: Multiplan Commercial	$0.95

VENLAFAXINE 37.5 MG TABLET [12207]

Facility

OP

$0.40

Service Code	NDC 57664-393-88
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.24
Rate for Payer: Aetna of CA Government/Medicare	$0.24
Rate for Payer: Cash Price	$0.22
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.24
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.24
Rate for Payer: LLUH Dept of Risk Management WC	$0.22
Rate for Payer: Multiplan Commercial	$0.30

VENLAFAXINE 37.5 MG TABLET [12207]

Facility

IP

$1.03

Service Code	NDC 68084-844-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.82
Rate for Payer: Cash Price	$0.57
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.82
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: Multiplan Commercial	$0.77

VENLAFAXINE 37.5 MG TABLET [12207]

Facility

OP

$1.03

Service Code	NDC 68084-844-11
Hospital Charge Code	901700029
Hospital Revenue Code	259
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$0.82
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.62
Rate for Payer: Aetna of CA Government/Medicare	$0.62
Rate for Payer: Cash Price	$0.57
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$0.82
Rate for Payer: Health Smart Auto/Commercial	$0.62
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.62
Rate for Payer: LLUH Dept of Risk Management WC	$0.57
Rate for Payer: Multiplan Commercial	$0.77

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