Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]

Facility

IP

$0.66

Service Code	NDC 68084-709-01
Hospital Charge Code	1711722
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.53
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cigna of CA HMO/PPO	$0.53
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]

Facility

OP

$0.34

Service Code	NDC 0093-7385-98
Hospital Charge Code	1711722
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.26
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.20
Rate for Payer: Aetna of CA Government/Medicare	$0.20
Rate for Payer: Cash Price	$0.15
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]

Facility

IP

$0.34

Service Code	NDC 0093-7385-98
Hospital Charge Code	1711722
Hospital Revenue Code	259
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.27
Rate for Payer: Cash Price	$0.15
Rate for Payer: Cigna of CA HMO/PPO	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.20
Rate for Payer: LLUH Dept of Risk Management WC	$0.19
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.26

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]

Facility

IP

$0.38

Service Code	NDC 68382-035-16
Hospital Charge Code	1711722
Hospital Revenue Code	259
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.30
Rate for Payer: Cash Price	$0.17
Rate for Payer: Cigna of CA HMO/PPO	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.29

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]

Facility

OP

$0.66

Service Code	NDC 68084-709-01
Hospital Charge Code	1711722
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.40
Rate for Payer: Aetna of CA Government/Medicare	$0.40
Rate for Payer: Cash Price	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]

Facility

IP

$0.39

Service Code	NDC 65862-528-90
Hospital Charge Code	1711722
Hospital Revenue Code	259
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.31
Rate for Payer: Cash Price	$0.18
Rate for Payer: Cigna of CA HMO/PPO	$0.31
Rate for Payer: Health Smart Auto/Commercial	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.29

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]

Facility

IP

$0.63

Service Code	NDC 0904-6469-61
Hospital Charge Code	1711722
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.50
Rate for Payer: Cash Price	$0.28
Rate for Payer: Cigna of CA HMO/PPO	$0.50
Rate for Payer: Health Smart Auto/Commercial	$0.38
Rate for Payer: LLUH Dept of Risk Management WC	$0.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.47

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]

Facility

OP

$0.63

Service Code	NDC 0904-6469-61
Hospital Charge Code	1711722
Hospital Revenue Code	259
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.38
Rate for Payer: Aetna of CA Government/Medicare	$0.38
Rate for Payer: Cash Price	$0.28
Rate for Payer: Health Smart Auto/Commercial	$0.38
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.38
Rate for Payer: LLUH Dept of Risk Management WC	$0.35
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.47

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]

Facility

OP

$0.39

Service Code	NDC 65862-528-90
Hospital Charge Code	1711722
Hospital Revenue Code	259
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.23
Rate for Payer: Aetna of CA Government/Medicare	$0.23
Rate for Payer: Cash Price	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.29

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]

Facility

IP

$0.66

Service Code	NDC 68084-709-11
Hospital Charge Code	1711722
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.53
Rate for Payer: Cash Price	$0.30
Rate for Payer: Cigna of CA HMO/PPO	$0.53
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]

Facility

OP

$0.66

Service Code	NDC 68084-709-11
Hospital Charge Code	1711722
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.40
Rate for Payer: Aetna of CA Government/Medicare	$0.40
Rate for Payer: Cash Price	$0.30
Rate for Payer: Health Smart Auto/Commercial	$0.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.40
Rate for Payer: LLUH Dept of Risk Management WC	$0.36
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.50

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]

Facility

OP

$0.38

Service Code	NDC 68382-035-16
Hospital Charge Code	1711722
Hospital Revenue Code	259
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.29
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.23
Rate for Payer: Aetna of CA Government/Medicare	$0.23
Rate for Payer: Cash Price	$0.17
Rate for Payer: Health Smart Auto/Commercial	$0.23
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.23
Rate for Payer: LLUH Dept of Risk Management WC	$0.21
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.29

VERAPAMIL 120 MG TABLET [8528]

Facility

IP

$0.09

Service Code	NDC 0591-0345-01
Hospital Charge Code	1710498
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
Rate for Payer: Cash Price	$0.04
Rate for Payer: Cigna of CA HMO/PPO	$0.07
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.07

VERAPAMIL 120 MG TABLET [8528]

Facility

OP

$0.12

Service Code	NDC 0904-2924-61
Hospital Charge Code	1710498
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.07
Rate for Payer: Aetna of CA Government/Medicare	$0.07
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.09

VERAPAMIL 120 MG TABLET [8528]

Facility

IP

$0.12

Service Code	NDC 0904-2924-61
Hospital Charge Code	1710498
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.09

VERAPAMIL 120 MG TABLET [8528]

Facility

OP

$0.09

Service Code	NDC 0591-0345-01
Hospital Charge Code	1710498
Hospital Revenue Code	259
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.07
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.05
Rate for Payer: Aetna of CA Government/Medicare	$0.05
Rate for Payer: Cash Price	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.05
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.05
Rate for Payer: LLUH Dept of Risk Management WC	$0.05
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.07

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

IP

$19.29

Service Code	NDC 51754-0203-1
Hospital Charge Code	1720156
Hospital Revenue Code	250
Min. Negotiated Rate	$10.61
Max. Negotiated Rate	$15.43
Rate for Payer: Cash Price	$8.68
Rate for Payer: Cigna of CA HMO/PPO	$15.43
Rate for Payer: Health Smart Auto/Commercial	$11.57
Rate for Payer: LLUH Dept of Risk Management WC	$10.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.47

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

OP

$6.00

Service Code	NDC 70069-271-01
Hospital Charge Code	1720156
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

OP

$19.29

Service Code	NDC 51754-0203-1
Hospital Charge Code	1720156
Hospital Revenue Code	250
Min. Negotiated Rate	$10.61
Max. Negotiated Rate	$14.47
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$11.57
Rate for Payer: Aetna of CA Government/Medicare	$11.57
Rate for Payer: Cash Price	$8.68
Rate for Payer: Health Smart Auto/Commercial	$11.57
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$11.57
Rate for Payer: LLUH Dept of Risk Management WC	$10.61
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$14.47

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

OP

$5.99

Service Code	NDC 72485-108-01
Hospital Charge Code	1720156
Hospital Revenue Code	250
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$4.49
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.59
Rate for Payer: Aetna of CA Government/Medicare	$3.59
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Smart Auto/Commercial	$3.59
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.59
Rate for Payer: LLUH Dept of Risk Management WC	$3.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.49

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

OP

$6.00

Service Code	NDC 70069-271-25
Hospital Charge Code	1720156
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.60
Rate for Payer: Aetna of CA Government/Medicare	$3.60
Rate for Payer: Cash Price	$2.70
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

IP

$6.00

Service Code	NDC 70069-271-01
Hospital Charge Code	1720156
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

IP

$6.00

Service Code	NDC 70710-1643-1
Hospital Charge Code	1720156
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

IP

$6.00

Service Code	NDC 70069-271-05
Hospital Charge Code	1720156
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.80
Rate for Payer: Health Smart Auto/Commercial	$3.60
Rate for Payer: LLUH Dept of Risk Management WC	$3.30
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.50

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

IP

$5.99

Service Code	NDC 72485-108-05
Hospital Charge Code	1720156
Hospital Revenue Code	250
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$4.79
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna of CA HMO/PPO	$4.79
Rate for Payer: Health Smart Auto/Commercial	$3.59
Rate for Payer: LLUH Dept of Risk Management WC	$3.29
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.49

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